HomeMy WebLinkAboutApplication - PermitGarfield County
Building & Planning DePartment
108 8th Street Suite 401
Glenwood Springs, CO 81601-
Phone: (970)945-8212 Faxi (970)384-3470
Parcel No.Subdivision Section Township RangeProject Address
lssue Date: Not lssued Expires: 01/01/2999
6516 CR 301
Rifle, GO
240507200047 7 947
CallOwnerAddressPhone
6516 CR 301
co 970-6254087Karla Jacobs
Gontractor(s Phone Primary Contractor
Rooter-man Plumbing (970)625-2100 Yes
Required lnspections:
For rnspections carr ' I (888)868-5306
lnspection IVRProposed Construction / Details
repa¡r septic tank
FEES DUE
Fee Amount
Septic Fee - Alteration or ReP,
Total:
$73.00
$73.00
Valuation:
Total Sq Feet:
$ o.oo
0
FEES PAID
lnv Total Paytype Amt Paid Amt Due
lnv # SEPT-4-10-20184
$ 73.00 Check # 5904 $73.00
$ o.oo Building Department
copy
See Permit Record
2Tuesday, April27,2010
GARFIELD COLINTY SEPTIC PERMIT APPLICATION
108 8th Sûeet, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-38 4-3470 / Inspection Line: 970-384-5003
t Parcel No: (lhis informatiqn is available al the assessors office 970-9459134)
;2¿JÒ5n7 JbÐ111
2 provide Cr, Hwy or Street Name &or and(¡f an address has not been description
3 5 No:SuLot Exemption
Mailing Address
é5/¿ C'( 3at éa5- qo81
Ph:AIt Ph:
o! /a
4 Owner: (property owner)
Kn1un îxeoss
þ5: Ë%ï: -xsl sr tr. ;lbeA Ph:
è25 -2toa vweí;¿"5 Contractor:
RoofÉR- rvlArJ P LvmB ¡¿1"
6 ñTiÞv orrrÞftS Mailing Address Ph:AIt Ph:
7 PERMIT REQUEST FOR:( ) New lnstallation ( ) Alteration þ{Repair
I ( )Dwelling ( )Transient Use ( )Commercial or industrial ( )Non- Domestic wastesI ìOther - Describe
WASTE TYPE
9
Garbage Grinderf(Yes ( )No
BUILDING OR SERVICE TYPE:
Number of bedrooms
10 Þ4WELL ( )SPRTNG ( )STREAM OR CREEK ( )C|STERN
lf supplied by COMMUNITY WATER, give name of
SOURCE & TYPE OF WATER SUPPLY:
ll DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM N/4
Was an effort made to connect to the Community System?
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
Depthto1rGroundWaterTable-PercentGroundSlope-GROUND CONDITIONS:12
13 TYPE OF tNDtVtDUAL SEWAGE DISPOSAL SYSTEM (ISDS)PROPOSED:
( )Vault ( )Vault Privy ( )Composting Toilet( )Pit Privy ( )lncineration Toilet ( )ChemicalToiletUse( )Recycling, PotableI )Other- Describe
ldSeptic Tank ( )Aeration Plant( )Recycling, other use
t4 FINAL DISPOSAL BY:
þ{Absorption trench, Bed or Pit
( )Wastewater pond
( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
l5 Will effluent be discharged direclly into waters of the state? ( )YES 0(I0
I6 PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes-perinchinholeNo.1Minutes-perinchinholeNo'3Minutes-perinchinholeNo.2Minutes-perinchinholeNo.-
Name, address & telephone of RPE responsible for design of the system:
Name, address & telephone of RPE who made soil absorption laci'
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 conect to the best of my knowledge and belief
andaredesignedtobereliedonbythelocal departmentofhealthinevaluatingthesameforpurposesofissuingthepermitappliedforherein. lfurther
or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application
DATE
and action
test and reports as may be required byup0nApplicant acknowledges that the completeness of the application
that any
AS by law
17
ı"fnc{ t L, }nno lðca5 e coL'ol)\^A
S at(tt u
Permit Fee:
a3
Perk Fee:loc
Total fees
\13
B uilding Permit #:
l\r1A
Septic Permit #:
seÞl-- Lr-ro- l5ı t
Issue Date:
Lr-)3-ìO
Building & Planning Dept:
AL
F\\A
DÄTE
b
P 27/ZØIØ ØB: ØF
DEPARTNfrENT
97ø8755s54
,[tq¡uter ft#am Ftn¡¡¡r bË¡n
PO BoxZEZ
silr, co s1652
(970) s76-0700
Ë-'æx Kr¿n srsffsj d"tsH ff'orur¡
To: Garfielcl County
Name: Ken Smith
CC' ijt"_pl"r for Karja Jacaþg65i6 CR 301
Paraçhulso CO 81635
Phone: 970-g4S-gZI2
Fax: 970-3 g4_3470
OWENS 5EPT]C SERV]CE PAGE ø2/Ø2
w \ r ¡t *r\n', nl\
OhiENS SEPT]C SERVICtr PAGE ø1./Ø2
From: Andrew
Date Sent 04-27-rc
Number of pages: 2
Hf,ere is ÉAn e ,Sfte Hrlmm Éfumf y$¡ã Ã.flqwe$Éed.
APË3ffiffihfffiffi
J-U&TECT TO NOTÐÐ
DKCTT'TIONS & INSIIECi¡OWS
GARFIETD COUNTi
NETD
Bv kl+SJ_^'
COPY
¡ro=rys_PEcïroNWrrfi or}T
IfrFAEPI.ANS ONSITEpsgt of