HomeMy WebLinkAboutApplicationGarfield County
'Comr,nity Development Department
01314.„001139 8th Street, Suite 401
,c .p,��Gc Glenwood Springs, CO 81601
(970) 945-8212
www.garrieid-county.coni
.Pki'leG'n9
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
❑ New Installation
•
Alteration
I
• Repair
WASTE TYPE
o Dwelling
•
Transient Use
• Comm./industrial
j ❑ Non -Domestic
• Other Describe
INVOLVED PARTIES
Property Owner: Norhu LLC
Mailing Address: PO Box 103 Snowmass CO 81654
Email Address:
Phone: ( )
Contractor: Janckila Construction Phone: ((970) 319.3650)
Mailing Address: 75 Buckskin Dr Carbondale 0081623
Email Address: Pete@janckilacenatruction•cum
Engineer: All Service Septic
Phone: ( (3")"3 3P3i
Mailing Address: 33 Four Wheel Drive RO Carbondale CO 81623
Email Address:
PROJECT NAME AND LOCATION
Job Address: TBD Cattle Creek Ridge Rd Carbondale CO
Assessor's Parcel Number: 2391-072-01-015 Sub. Ranch al Coulter Creek
Building or Service Type: Dwelling
Distance to Nearest Community Sewer System: 'r.• •
Was an effort made to connect to the Community Sewer System:
Lot 15 Block
#Bedrooms: 3 Garbage Disposal(Y/N) Y
Type of OWTS
Ground Conditions
Final Disposal by
Water Source & Type
Effluent
I I Septic Tank
0 Aeration Plant
O Recycling, Potable Use
O Chemical Toilet
0 Vault
0 Vault Privy
O Recycling I 0 Pit Privy
0 Composting Toilet
0 Incineration Toilet
0 Other
Depth to 15e Ground water table
O Absorption trench, Bed or Pit
O Evapotranspiration
Percent Ground Slope 5%
0 Underground Dispersal
O Wastewater Pond
0 Above Ground Dispersal
0 Sand Filter
O Other
O Well _I
0 Spring 0 Stream or Creek
O Community Water System Name C"Itel Creek Ranch
0 Cistern
Will Effluent be discharged directly into waters of the State?
❑ Yes El No
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additional test and reports as may be required by the local health department to be
made and furnished by the applicant or by the local health department for purposed of the evaluation
of the application; and the issuance of the permit is subject to such terms and conditions as deemed
necessary to 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. I
further understand that any falsification 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
hav r-ovid• . the required inforrnatighich is correct and accurate to the best of my knowledge.
Property Owner Print a
Date
—/ —/
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
IZ$.Dj
Perk Fee:Total
1N1a
Fees:
IL.00
Fees Paid:
113 up
Building Permit
(.. - �!7
Septic Permit:
s �>!7
Issue Date:
q-�(S J I
Balance Due:
V
o
BUILDING/ PLANNING DIVISION:
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P 7:28:28
Si : ned ]Tr al
Date
(� QUA +1 3"1`i, 4-06(