HomeMy WebLinkAboutApplication.,.
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Community Develop'mem 1 ~~·~~~ment
108 81
h Street, Suite 401 -'
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
181 New Installation
WASTE TYPE
D Alteration
D Dwelling D Tran sient Use ~ Co imrn /lndust r iat
D Other Describe
D Repair
D Non-Domestic
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INVOLVED PARTIES
Property Owner: ...;..P..;.:lu=s"-'-F-'-iv:....;:e;_;:L=L=C;..;... -------------Phone: ( 970 )~2 ..... 16_-..... 18~1~8 ___ _
Mailing Address: 2278 J-1/4 Road. Grand Junction. CO 81505
Contractor: Ford Construction Company. Inc. Phone: ( 970 l ... 2....,45.._-9""3'-'4,._3 ___ _
Mailing Address: 560 25 Road. Grand Junction. CO 81505
Engineer: DWT & Associates Phone: ( 970 )_2_6~1-~15_1~7 ___ _
Mailing Address: 667 Coppe r Canyon Dr .. Grand Junction. CO 81505
PROJECT NAME AND LOCATION
Job Address: Lots between Scarrow Ave . & Walker Ave ., west of 3rd Street (no actua l address)
Assessor's Parcel Number: 2409-284-03-001 Sub. __ T_r_av_e_l!_ers_H ..... ig._h_la_n_d_s_ lot 3-24 Block 10
Building or Service Type: __ M_e_ta_I B_u_i_ld_in ... g_l_ln_d_us_t_ria_I __ #Bedrooms: __ n_la __ Garbage Grinder No
Distance to Nearest Community Sewer System: _U_n_k_n_ow_n _________________ _
Was an effort made to connect to the Community Sewer System: _N_o ____________ _
j Type of OWTS ~ Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy Cl Composting Toilet '
Cl Recycling, Potable Use 0 Recycling D Pit Privy D Incineration Toilet
0 Chemical Toilet Cl Other __________________ _
' Ground Conditions Depth to 111 Ground water table >10 feet Percent Ground Slope _4_% _____ _
Final Disposal by !I Absorption trench, Bed or Pit D Underground Dispersal Cl Above Ground Dispersa l
D Evapotranspiration D Wastewater Pond D Sand Filter
0 Other--------------------------~
Water Source & Type ~ Well Cl Spring D Stream or Creek D Cistern
0 Community Water System Name _________________ _
Effluent Will Effluent be discharged directly into waters of the State? D Yes ~ No
'
CERTI Fl CATION
Applicant acknowledges that th e completeness of the application is conditional upon such further
mandatory and additional test and reports as may be required by the local hea lth department to be
made and furnished by the app licant or by the local health department for purposed of the evaluation
of the application; and the issuance of the permit is subject to such terms and conditi ons as deemed
necessary to insure compliance with rules and regulations made, lnformation and reports submitted
herewith and required to be submitted by the applicant are or will be represented to be true and
correct to the best of my knowledge and belief and are designed to be relied on by the local
department of health in evaluating the same for purposes of issuing the permit app li ed for herein. l
further understand that any falsification or misrepresentation may result in the den ial of the
application or revocation of any permit granted based upon said application and lega l action for perjury
as provided by Jaw.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provide e requfrecT~nformation which is correct and accurate to the best of my knowledge.
LU~ ' ?c . w~ J ) __ ------'---'! l-----'-1.._._J·__,__( \j
Date
OFFICIAL USE ONLY
Special Conditions: ~lJl!A.lq f-. '-1-U
Fees Paid: C('.)
'$Q_ .
Permit Fee: C()
1' l;;r.3.
Perk Fee:
_ J-
Total Fees: .pµ
Building Permit Septic Permit: Issue Date: Balance Due:
~o.~
/-7-1.Dt
DATE