HomeMy WebLinkAboutApplicationGørfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82L2
www. garfi eld-countv.com
TYPE OF CONSTRUCTION
,E Repairtr New lnstallation tl Alteration
WASTE TYPE V
tr Non-DomesticEKDwellineE Transient Use tr Comm./lndustrial
b oìner Describe
tNVOIVED PARTTES^.-
Property Owner:
Mailing Address:
Phone:
f ô >o
EmailAddress:
Contractor: \---Phone:
Mailing Address
EmailAddress:
Engineer:'-----'Phone:
Mailing Address:
EmailAddress:
PROJECT NAME AND LgCATI9N îth
Job Address:
Assessoy's Parcel Number Q¡ ¡JT Lot Block
Building or Service Type:5.; /( lcrnri - #Bedrooms: vl Garbage Disposal _'t/
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Type of OWTS Septic Tank E Aerat¡on Plant E Vault E vault Privy tr Composting Toilet
E Recycling, Potable Use [1 Recycling E P¡t Pr¡vy E lncineration Toilet
E Chemical Toilet E Other
Ground Conditions Depth to lst Ground water table Percent Ground Slope
FinalDisposalby ,(Absorption trench, Bed or Pit E Underground Dispersal E Above Ground Dispersal
E Evapotranspiration E Wastewater Pond E Sand Filter
E other
Water Source & Type $.(ett E Spring E Stream or Creek E Cistern
E Community Water System Name
Effluent Will Effluent be discharged directly ¡nto waters of the State? E Yes ftf o
CERT¡FICATION
I hereby that I have
have the req uired i
read and understand the Notice and Certification above as well as
ation which is correct and accurate to the best of my knowledge.
Date
OFFICIAT USE ONLY
Special Conditions:
,.r^rtr7í: OO Perk Fee:oO,z-{o-
Total Fees:z^z { o"j'"#Þ€,*
ø"itffi Septic Permit:
\lÞ=?r-- 41aÞLt
lssue Date:
4-/3-/7
,","ryw,û
î
a 4-/3*/7BLDG DIV:
DATE