HomeMy WebLinkAboutApplicationc:G Garfield Co1111ty
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
I TYPE OF CONSTRUCTION l it--lnstallati~--------'~D __ A_lt_;_ra_t _io_n_-=====-=--=--=--=--~--_-O_R_e_p.~a~ir===========~~-l
TYPE
-Dwelling I D Transient Use =ro C_o_m_m-.-,-,n-d-us_!_r_i-a_l-_~---_-_,_r-_-D~~~N~o~n~-D~o~m~_e-s~t_i-c __ ~
D Other Describe ~=====================--=================
----------INVOLVED PARTIES
Property Owner: ~l .. &e:. t_-sL:H .. .:!}
Mailing Address : P 0 . Boy 9 §" 3 1 5; I + r C...O
Phone: (.._.'i_.7 .... o,__,_... ..... Cf..._-..... 3...;:;~ ..... 7_!> _ _..,
'i lbS-2-
-Contractor: Hm I!-Pt.a•t er-Phone: (flL) 31 2 -~(.../<..>
Malling Address: ____________________________ _
Engine.;;: V"'1'\c( }(.'°() e ~ £"'1t~~.7 Phone: ( '"/J5 ) 7$'1~ <;p/'(~
Mailing Address : 170 11¢>4 17 '>'i?, ilU'n.J, wf:. ~P7i
I
PROJECT NAME AND LOCATION
Job Address: ~ ;;_ 5 L 'J .'-:fie_ t'.? u I r,"°2?
Assessor's Parcel Number: .:l.t2.7).7'"JOI OO l Sub . S.'/f Jk,'oh f 'i
Building or Service Type: l?e s: tf e,1 ce_
Lot Block
#Bedrooms: 3 Garbage Grinder A..b
Distance to Nearest Community Sewer System: _t./_-{_fl1«_·_~_e5 _____________ _
Was an effort made to connect to the Community Sewer System: ,J ~ -J.o,., f.u-"''°"
TypeofOWTS
~·~o1rat1 Sy~~
KtJu :N J .
Ground Conditions
Final Disposal by
Water Source & Type
Effluent
eptlc Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Tollet
0 Recycling. Potable Use C Recydlng 0 Pit Privy 0 Incineration Toilet
0 Chemical Tollet 0 Oilier ________________ _
j Depili to 1' Ground water table ----j Pe rcent Ground Slope ------
Ji(Absorptlon trench, Bed or Pit C Underground Dispersal 0 Above Ground Olspe!'HI
0 Evapotransplratlon 0 Wastew ater Pond 0 Sand Riter
0 O~er--------------------------
Well 0 Spring C Stream or Creek 0 Cistern
~--·'-----~~------.... ---0 Comm unity Water System Nam e _________________ _
WIU Effluent be discharged directly Into waters of the State? 0 Yes 0
CERTIFICATION
Applicant acknowledges that the completeness of the applkaifon is conditional upon suchfurther
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
I necessary to insure compliance with rules and regulations made, information and reports submitted I 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 Certi fication above as well as
have provided the required Information which Is correct and accurate to the best of my knowledge.
4,;~it.~.~l;:L~J ~ 0?!2 9 /1 ~
OFFICIAL USE ONLY
' Special Conditions:
E11 ""'e111etl Se 'J/i ~ :JJll tHll-1/ ,fa.tr>HtJr/ ,1/!. ~t'~e CfJ11AJ1J /lLJ ;# dt'11pH.
BLDG DIV: ..,4_ ..... ·~~---..,._&_;c:;;_-:Z_....,~....___/_~--------------
APPROVAL