HomeMy WebLinkAboutApplicationGarfield Coa,nty ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATIONìlïhR 1 3 t01T
Community Development Department
108 8'h street, Suite 401
Glenwood Springs, CO 81601
(e7ole4s-82r-2
www.garfield-cou ntv.com
WPE OF CONSTRUCTION
Ø ruew lnstallation El Alteration tr Repair
WASTE TYPE
V Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic
E Other Describe
INVOTVED PARTIES
Property Owner:
Mailing Address:
Phone:
Ò 0
Phone
f,oMailing Address:
Contractor:
Engineer: Phone
Mailing Address:
PROJECT NAME AND LOCATION
As s ess o r's Pa rce I N u m b e r : 234á_2?,_4þ-0 003sub.
Was an effort made to connect to the Community Sewer System
+Building or Service Type b¿çl/h.frø I #Bedrooms:
tot / 0 Block_
Garbage erinder p0
Distance to Nearest Community Sewer System
Job Address:
El SepticTank D Aeration Plant E vault E vault Privy tr Composting Toilet
EI Recycling tr P¡t Pf¡wE Recycling, Potable Use E lncineration Toilet
Type of OWTS
E Chemical Toilet E other
Ground Conditions Depth to ltt Ground water table Percent Ground Slope
El Underground DispersalEf Absorption trench, Bed or Pit E Above Ground Dispersal
E Evapotranspirat¡on E Wastewater Pond E Sand Filter
E other
FinalDisposalby
E Spring E Stream or Creek E CisternElweltWater Source & Type
E Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? E Yes E ltlo
I hereby acknowledge that I have read and understand the Not¡ce and Certification above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
ff
Property Owner Print and Sign
lU # næ Ð, Þ ßeùV€'Ø) 3 t7 IT
Iv
Date
l0o FlSpecial Conditions:
\
2V, -Fees Paid:n7-Total Fy'es:Perm¡t Fee
11,7 -Perk Fee:
I sô -
lssue Date:3,At-Ì?Balance Due:Septic Perm¡t:,
S{fÆ-útazb
Building Permit
RI RV. '+VLL
^3)'zst
BLDG DIV:
DATEAPPROVAL