HomeMy WebLinkAboutApplicationGarfield County]
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-countv.com
TYPE OF CONSTRUCTION
CI New Installation
1 WASTE TYPE
Dwelling ❑ Transient Use
❑ Other Describe
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
❑ Comm./Industrial
0 Repair
0 Non -Domestic
j INVOLVED PARTIES
Property Owner: Jonathon Whitman
Mailing Address: R090* 1236 Carbondale Co 81623
Contractor: Crawford Design Build LLC
Phone: ( 970 ) 927.5204
Mailing Address: PO Box 1236 Carbondale Co 81623
1 -Engineer: Dale Naup
Phone: ( 970 ) 618.4346
Mailing Address: 4264 Camwadh Road, Tallahassee,F1 32303
PROJECT NAME AND LOCATION
Job Address: 20 SilverSpruce Drive
Phone: ( 970 ) 945 9613
Assessor's Parcel Number: 239336219002 Sub. Roaring Fork Preserve
Building or Service Type: Residential
Distance to Nearest Community Sewer System: 5 Miles
Was an effort made to connect to the Community Sewer System: No No
Lot 2 Block
#Bedrooms: 3 Garbage Grinder Y
Type of OWTS
0 Septic Tank IH Aeration Plant
0 Vault I 0 Vault Privy 0 Composting Toilet
0 Recyding, Potable Use
0 Recycling
El Pit Privy
0 Incineration Toilet
0 Chemical Toilet
0 Other
Ground Conditions
Depth to 1`r Ground water table
7 Fer t ' Percent
Ground Slope 2%
Final Disposal by
0 Absorption trench, Bed or Pit 1 0 Underground Dispersal I El Above Ground Dispersal
0 Evapotranspiration
0 Wastewater Pond
El Sand Filter
o Other FAculd
Water Source & Type
O Well
0 Spring I 0 Stream or Creek I 0 Cistern
0 Community Water System
Name
Effluent
Will Effluent be discharged directly into waters of the State? 0 Yes O No
CERTIFICATION
Applicant acknow edges 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.
hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information whic; .incorrect and accurate to the best of my knowledge.
Property Owner Print and Sign
9/28/2016
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee: 4515Perk
1)123.
Fee:
C/.
Total Fees:
11x3.°d
Fees Paid:
4/R3.°el
Building Permit
zE- 4y'4 t
Septic Permit:
SEP- LILA
Issue Dap:
1 Iftiti
Balance Due: 0O
BLDG DIV:
1 �� II/4/HO
APPROVAL
DATE