HomeMy WebLinkAboutApplicationJUN 01 Z'
Garfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.Rarfield-county.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CON5TREICTION
El New Installation
r WASTE TYPE
r Dwelling
0 Transient Use
❑ Other Describe
0 Alteration
0 Comm /Industrial
0 Repair
0 Non -Domestic
INVOLVED PARTIES
Property Owner:.
Mailing Address:
ivt?es.trro, LLe
1906 SOUTH OCEAN BLVD., PALM BEACH FL 33480
Phone: ( )
Email Address:
Contractor: GIARD HOMES INC.
_-1
Mailing Address: 1431 AIRPORT RD., RIFLE CO 61650
Email Address: roger•glard®glardhomes.com
Phone: (1970) 625-2)47
Engineer: KRM CONSULTANTS
Mailing Address: PO BOX 4572, VAIL CO 81658
Email Address:
Phone: ((970)949-9991
PROJECT NAME AND LOCATION
Job Address: 2147 UTE STOCK DR., RIFLE CO 81650
Assessor's Parcel Number: 1877-254-00-014
Sub. Lot Block
Building or Service Type: NEW #Bedrooms:
Distance to Nearest Community Sewer System: 30 MILES
Was an effort made to connect to the Community Sewer System: NO
Garbage Disposal(Y/N)
Type of OWTS
fil Septic Tank 0 Aeration Plant 0 Vault
0 Vault Privy n Composting Toilet
O Recycling, Potable Use • 0 Recycling 0 Pit Privy
O Chemical Toilet 0 Other
0 Incineration Toilet
Ground Conditions
Depth to 1i0 Ground water table NONEENfdMTGEe Percent Ground Slope 7%
Final Disposal by
p Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal
O Evapotranspiration 0 Wastewater Pond 0 Sand Filter
O Other
Water Source & Type 0 Well
EEffiuerit
0 Spring 0 Stream or Creek
Cistern
0 Community Water System Name
Will Effluent be discharged directly Into Waters of the State? .:.0 Yes lil . No
CgRTIFICA lON
• Applicant acknowledges additional on Il t st and repleteness of the application is conditional upon such further
madeend furnished by the appilcani orb as may be required by the local health department to be
of tine application, and the issuance o i�e Permit a1 healthsubjecd to such terms apartment for nd conditions onsof h as deemed evaluation
necessaryto 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. 1
further
in understand that revocation of arny permit or misrepresentation may result in the denial of the
Y 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 the required informatlor hich is correct and accurate to the best of Jr►y knpwledge.
Property Owner Print and Sign
OFFICIAL USE ONLY
Date
(7
Special Conditions:
Permit Fee:
'
Building Permit
tl-
Perk Fee:
Septic Permit:
S4-)TT TlioD
BUILDING/ PLANNING DIVISION:
Signed Approval
PP. 00) Gam) (di III -
Total Fees:���
Issue Dai
Fees Paid:
Balance Due: 0
23/20 7
Date