HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Springs, CO 81601
(970194s-8212
www. ga rfield-county.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
TYPE OF.CONSTRIJCTION
tr New lnstallation EI Alteration tr Repair
WASTÊ TYPE
tr Dwelling E Transient Use E Comm./lndustrial tl Non-Domestic
El other Describe
INVOLVED PARTIES
Property Owner:CCC-B LLLP Phone:(e70 ì 927-4038 ext4
Mailing AddreSS: 132 ParkAve Basalt, CO 81621
Email Address:chris@ruddconstruct¡on.com
COntraCtOr: Rudd Construct¡on Phone:927-4038 ext 4
Mailing Address: 132 ParkAve Basalat, CO 81621
Email Address:chris@ruddconstruction.com
Engineer:Zancanella and Assoc¡ates, lnc.pþs¡s¡ (970 ) 945-5700
Mailing Address:P.O. Box l908 1005 CooperAve Glenwood Springs, CO 81602
Email Address:tbeck(@za-engineering.com
PRO¡ECT NAME AND I.OCATION
Job Address:0062 County Road 1 13, Carbondale, CO 81623 Bldg. D
Assessofs Parcel Numbg¡; 23e3-181-00-358 Sub.lot Block
Building or Service Type:F1 Warehouse Type ll #Bedrooms: Garbage Disposal(Y/N)-
D¡stance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Type of OWTS E¡ Sept¡cTank E Aeration Plant E Vault tl vault Privy f] ComnostingToilet
E Recycling, Potable Use E Recycling E eit erivy El lncineration Toilet
E Chemical Toilet E Other
Ground Conditions Depth to lst Ground water table Percent Ground Slope
Final Disposalby E Absorption trench, Bed or Pit E Underground Dispersal EI 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
E Community Water System Name
Effluent Will Effluent be discharged directly into waters of the state? EI Yes El ruo
Applicant acknowledges that the completeness of the application is conditiona! ypgn such further
n'iandatory and addítional 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 tó be submitted by the applicant are or will be repres€nted 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 app[ied for herein. I
further understand that any falsifiòation 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 Not¡ce and Certificat¡on above as well as
have provided the required information is correct and accurate to the best of my knowledge
Eric Rudd 3119t19
Property Owner Print and Sign Date
Pp.s ?ç.DD/ &t þ3 ælt1
Special Cond¡t¡ons:
Total Fees:Ts-Fees Paid:?lPerm¡t Fee:7{-Perk Fee:ENó.
Sept¡c Perm¡t:S€V?çbTT
lssue Date: ,7/qrq
Balance Due:,óBuilding Permit
ØtJå'ç4loL
BUILDING/ PTANNING DIVISION:
Signed Approval
lalzot<--
Date