HomeMy WebLinkAboutApplicationre Garfield County
Community Development Department
RECEIVED 108 8th Street, Suite 401
Glenwood Springs, CO 81601
JUL. 0 9 2019 (970) 945-8212
GARFIELD COUt�Yw.garfield-county.com
COMMUNITY DEVELOPMENT
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
❑ New Installation
WASTE TYPE
❑ Dwelling
1 0 Alteration
CI Repair
0 Transient Use
0 Comm./Industrial J 0 Non -Domestic
❑ Other Describe
INVOLVED PARTIES
Property Owner: C Spaniel LLC (Tenant is Green Dragon) Phone: ( 561 ) 314-3942
Mailing Address: 5499 N Federal Hwy Suite I
Email Address: AmyG@bestageny.com
Contractor: Joe Zamora - Zamora Excavating Inc. Phone: ( 970 ) 379-7171
Mailing Address: 17453 CO -82 Carbondale, CO 816622j3
Email Address: S err Z-4 Q t �` " M` ,A , fi 0 M
Engineer: N/A Phone: ( )
Mailing Address:
Email Address:
PROJECT NAME AND LOCATION
Job Address: 1420 Devereux Road Glenwood Springs, CO 81601
Assessor's Parcel Number: 218505415002 Sub. DDE Minor Lot 2 Block N/A
Building or Service Type: Commercial #Bedrooms: N/A Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System: N/A - Too far to connect to
Was an effort made to connect to the Community Sewer System; N/A - We would if it was close enough
Type of OWTS
i Septic Tank
0 Aeration Plant
0 Vault
0 Vault Privy
Composting Toilet
❑ Recycling, Potable Use
0 Recycling
0 Pit Privy
0 Incineration Toilet
0 Chemical Toilet
0 Other
Ground Conditions
Depth to 1St Ground water table NSA
Percent Ground Slope NIA_
Final Disposal by
Cal Absorption trench, Bed or Pit
0 Underground Dispersal
0 Above Ground Dispersal
❑ Evapotranspiration To Wastewater Pond 0 Sand Filter
❑ Other
Water Source & Type
0 Well
0 Spring
0 Stream or Creek
0 Cistern
Effluent
El Community Water System Name City of Glenwood Springs
Will Effluent be discharged directly Into waters of the State?
❑ Yes 0 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
have provided the required information which is correct and accurate to the best of my knowledge.
07/09/2019
Property Owner Print and Sign
-L;S 1,1-44t r
0.h.a, ( c afria" t,I L -L -C, Date
OFFICIAL USE ONLY ,pad
3- cilig � (i
Special Conditions:
�rad C .� r-61) �.C'f) 0 1.N R.S IC,0 A C-7 C -f1-& K. I ►�'
Permit Fe oo D
4.7
Perk Fee:
NI
Sept c Permit:
Total Fees:
03
Issue Date: Ill I 11
Fees Paid:
75 06
Bala D e:
co
Building Permit
BUILDING/ PLANNING DIVISION:
7—`,/-2,c. r1
Signed Appr•val Date