HomeMy WebLinkAboutApplicationGurfie,ld Cau.ntTt
Community Development Department
108 8th Street, su¡te 401
Glenwood Springs, CO 81601
1970194s-82L2
www.earfie .com
E New lnstallation
WASTE TVPE
tr Alteration ir
tr Non-DomesticComm./lndustrialtrtr Dwelling I Transient Use
flOther Describe
INVO[VED PARTIES
Phone: 1go ¡404-5093PropertyOWnef: KurtTfede
Mailing AddfeSS: PO Box 1'144, Carbondale, CO 81623
Email Address:æb01 88(tcenturyl¡nk.net
COntfaCtOf : L¡ttle D¡gs Excavat¡on, lnc.Phone: (,19_)3/9-l99tt
Mailing Address P O Box 3218, Glenwood Springs, CO 81602
Email Address:litüed¡9s206@gmail-mm
Engineer:All Serv¡ce Septic, llc
Mailing Address 33 Fou¡ Wrcel Or¡vc Rd, C¿rlrúudale, CO 81023
Email Address:carla.ostberg@gmârl.com
phone: teTo 1309-5259
.P.Ro¡CCT NRME AND LOCATION
Was an effort made to connect to the Community Sewer System
Job Address:0188 Willow Lane
Distance to Nearest Community Sewer System:One mile
.no
Building or Service Type Resident¡al
Assessor's Parce lNumber: 239335400027
fBedrooms: one Garbage Disposal(Y/Nln
SUb. Jack Sharp Trâcts Lot _ Block _
D Vault Privy I Comnosting ToiletEI SepticTank E Aeration Plant E vault
D lncineration ToiletE Pit Rrivy
E chemical To¡let El other
Type of OWTS
Percent Ground Slope 0Ground Conditions Depth to 1st Ground water ta ble 2'
E Above Ground DispersalE Absorpt¡on trench, Bed or Pit E Underground DispersalFinalDisposalby
EI Sand Filter
D other
E Spring E Stream orCreek El cisternE wellWater Source & Type
E Community Watar Systcm Name
r Effluent Will Effluent be discharged directly into waters of the State? E Yes El No
CERTIFICATION
Applicant acl<nowlcdges that the completeness of the applìcation i¡ conclitional l,p?n srrch further
;iJ;àä;;;;d ;;dif'loñ;í tãif rnlr"iorts ai may be req'uired by the local health de.partment to be
ffiffi;îi;;ìtî;äï;iË" ãó-pri.ãniãr by the loéal health department for pu.rposed.of the evaluation
äiìr,é ãópliðation; andt-hã¡ri,ñ"Ë äitrreí pãrmit is. subject to such terms and conditíons as deemed
necessary to insure ."tóld;* *itt' tr.igs ånd regulatio.ns T9.911,!,nformation and reports submitted
¡rıiã*iit"rn¿ requir"O Iå'UË s-u¡mitteà Uy tt'te -ap-plicant are or ryi!l !e ruqf9l"Il1!.to be_true and
.òiiuti i"ìr," ¡"!i otinît "owieáge
ano'bel¡ef ånd are designed to be relied on by the.local
ı;;rùì""ì ıfrrìalitr'¡n'e*i,jåtiñËihe same for purposes oi issuing the.permit a,pplied for herein. I
frih;i';;å;;;tä-"äTttri ãñv triiitiËuiion or misrepre'sentation may result in the denial of the
application or revocatio:n óf añv pãrmit granted based upon said ápplication 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
provided the information which is correct and accurate to the my knowledge.
Property Owner Print and Sign
Ð.12þ.æ ¡lM,t tç r1
OFFICIAT USE ONIY
Special Conditions:
Fees Paid 7â.oorotarFees:
r2z.soPerk Fee:Permit Fee:L9.to
Balance Due:lssuePerm¡t:
z,lø(n
Date
BUILDING/ PTANNING DIVISION:
Signed ApProval