HomeMy WebLinkAboutApplicationGarfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
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JUll I 21017
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Community Development Department
108 8th Stree! Suite 401
Glenwood Springs, CO 81601
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wwur.garfield-cou ntv.com
TYPE OF CONSTRUCTION
tr New lnstallation El Alteration tr Repair
WASTE TYPE
tr Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic
E Other Describe
INVOLVED PARTIES
Property OWngf: Karl Hanlon Phone: ((e70) 37e-2Iee
Mailing AddfeSS: PO Box 3188, Glenwood Springs, CO 8'1602
Email AddfeSS: kjh@mounta¡nlawr¡m.com
Contractor: rBD Phone: (_)
Mailing Address:
Email Address
Engineer:High Country Engineer¡ng Phone:(e70)
Mailing Add f eSS: 1 51 7 Blake Avenue, Glenwood Spr¡ngs CO 81 601
Email Address:rneal@hceng.com
PROJECT NAME AND LOCATION
JOb AddfgSS: 271 Willow Lane, Carbondale, CO 81623
Assessor's ParCel Number: 23e3-3s4-00-03e Grr b.Iot Block
Building or Service Type: sinsre Familv Home/ADU #Bedrooms: 6 Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System:N/A (several m¡les)
Was an effort made to connect to the Community Sewer System:NO
Type of OWTS E Sept¡cTank El Aeration Plant E vault E Vault Privy tr Composting Toilet
E Recycling, Potable Use E Recycling E eit erivy E lncineration Toilet
EI Chemical Toilet E other
Ground Conditions Depth to 1st Ground water table Percent Ground Slope
Final Disposal by E Absorption trench, Bed or Pit E Underground Dispersal El Above Ground Dispersal
E Evapotranspiration E Wastewater Pond E Sand Filter
E other
Water Source & Type E well E Spring E Stream or Creek E Cistern
El Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? E Yes E lto
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional ypgn such further
nia'ndatory and addii'ronal test and reþorts as Tay be required by the local health de.partment to be
made and'furnished by the applicant or by the local health department for pu.rposed of the evaluation
of the application; and the isiúance of the permit is subject to such terms and conditions as deemed
necessa'ry to insuie compliance with rules and regulations made,.information and.reports submitted
herewith'and required tö be submitted by the applicant are or will be repres.ented to be true and
correct to the beit of my knowledge and belief and are designed to be relied on by the.local
department of health in'evaluatinf the same for purposes of issuing the. permit a.pplie.d for herein. I
furiher understand that any falsifiéation 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 Certification above as well as
have provided required information which is correct and accurate to the best of my knowledge.
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OFFICIAL USE ONtY
Specif\Conditíons: ^""='iJ-riö' lm*,,z ?,uotxv
Fees Paid:?<Total Fees:7çPermit Fee:qç Perk Fee:
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Balance Due:
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L-/L'b/BUITDING/ PLANNING DIVISION:
Date