HomeMy WebLinkAboutApplicationni
Garfield County 1
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.earfield-county.com
TYPE OF CONSTRUCTION
e1 New Installation
WASTE TYPE
® Dwelling
❑ Other Describe
0 Transient Use
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
0 Repair
0 Comm/Industrial 0 Non -Domestic
INVOLVED PARTIES
Property owner: 4J LLC, ATTN: JOLLEY JEANNE & B ETTphone• ( 970
Mailing Address: 1288 COUNTY ROAD 245, NEW CASTLE, CO, 81647
Contractor:
984-3562
Mailing Address:
Phone:
{
Engineer: Sopris Engineering, LLC, Paul Rutledge Phone: ( 970 ) 704-0311
Mailing Address: 502 Main Street -Ste A3, Carbondale, CO 81623
PROJECT NAME AND LOCATION
Job Address: Jolley Residence, 1793 245 COUNTY RD NEW CASTLE
TR IN NENW & SENW AKA PARCEL B HUBER EXEMPTION
Assessor's Parcel Number: 212525200132 Sub. Lot Block
Building or Service Type: Single Family
#Bedrooms:
4
Garbage Grinder No
Distance to Nearest Community Sewer System: 314 mile
Was an effort made to connect to the Community Sewer System: No
Type of OWTS El Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet
O Recycling, Potable Use 0 Recycling 0 Pit Privy 0 Incineration Toilet
O Chemical Toilet
® Other 3 -comp wl dosing pump chamber
i
Ground Conditions
Depth to In Ground water table > 10'
Percent Ground Slope 10%
Final Disposal by ! 1 Absorption trench, Bed or Pit
0 Underground Dispersal ' 0 Above Ground Dispersal
O Evapotranspiration 0 Wastewater Pond
0 Sand Filter
ES Other Full pressure dosed chamber trenches
Water Source & Type Q9 Well 0 Spring
❑ Stream or Creek ❑ Cistern
❑ Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? 0 Yes Si No
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additional test and reports as may be required by the local health department to be
made and furnished by the applicant 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 conditions as deemed
necessary to insure compliance with rules and regulations made, information 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 applied for herein. I
further understand that any falsification or misrepresentation may result in the denial of the
application or revocation of any permit granted based upon said application and legal action for perjury
as provided by law.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have rovit d the r quir - • rmation which is correct and accurate to the best of my knowledge.
Property Owner int and
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
I? -3• DO
Perk Fee:Total
AJCi
Fees:
/23.00
Fees Paid:
1Z3 .DQ
BBuildidinng Permit
tl
septic Per it:
Oil 1 4
Issue
1
�t%e: +
Balance Due:
BLDG DIV:
iii
945 s
APPROVAL DATE
pa- 14)-3.00, ins,°ilglis