HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.earfield-countv.com
TYPE OF CONSTRUCTION
O New Installation
WASTE TYPE
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
I, 0 Alteration
❑ Dwelling 1 ❑ Transient Use [ ® Comm./Industrial 1 0 Non -Domestic
❑ Other Describe Two OWTS Systems being designed, one for a single bathroom, one for production room waste.
INVOLVED PARTIES
Property Owner: Ken Sack
Mailing Address: 402 County Road 315, Silt, CO 81652
Phone: ( 970 ) 930-5965
Contractor: Phone: (
Mailing Address:
Engineer: Ail service Seo"
Mailing Address: 33 Four wheel Drive Road, Carbondale, CO 81623
PROJECT NAME AND LOCATION
Phone: ( 970 ) 309.5259
Job Address: 482 County Road 315, Silt, CO 81652
Assessor's Parcel Number: 2179.181-00.601
Building or Service Type: Meat Processing Plant
Sub. Lot Block
t/Bedrooms: Garbage Grinder
Distance to Nearest Community Sewer System: Approximately 1 mile
Was an effort made to connect to the Community Sewer System: No
Type of OWTS
D 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
❑ Chemical Toilet 0 Other
Ground Conditions Depth to i' Ground water table no
Percent Ground Slope 7.
Final Disposal by 0 Absorption trench, Bed or Pit 0 Underground Dispersal
❑ Evapotranspiration
❑ Other
0 Above Ground Dispersal
0 Wastewater Pond
0 Sand Filter
Water Source & Type
O Well 1 0 Spring
0 Stream or Creek I 0 Cistern
O Community Water System Name
Effluent
Will Effluent be discharged directly into waters of the State?
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.
1 hereby acknowledge that 1 have re.�, and understand the Notice and Certification above as well as
have provi he required informatio which i A,►. rrect and accurate to the best of my knowledge.
10/15/15
Property Owner Print and Sign
Date
OFFICIAL USE ONLY
Special Conditions: 2J
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Permit Fee:
erk Fee:
Total Fees:
Fees Paid:
Building Permit
Septic Permit:
Issue D te:
Balance Due:
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DATE