HomeMy WebLinkAboutApplication - PermitProject Address
Garfield County
Building & Planning Department
108 8th Street Suite 401
Glenwood Springs, CO 81601-
Phone: (970)945-8212 Fax: (970)384-3470
Parcel No.Subd¡vision Section Townsh¡p Range
Issue Date: 8125/,2011 Expires: 0812412012
585 CTNDY'S WAY
RIFLE, CO
212733400188
Owner lnformation Address Cell
585 Cindys WAY
Rifle CO 81650
970-309-0319James William Ziegler
Gontractorls)Phone Primary Contractor
Silt Mesa Excavating (970)876-0r55 Yes
Proposed Construction / Details
New septic system for a detached garage.
Required lnspections:
For rnspêct¡ons ca"' I (888)868-5306
lnspection IVR
FEES DUE FEES PAID
lnv Total Paytype Amû Paid Amt Due
lnv # SEPT-8-11-2'1347
$ 73.00 Check # 2563 $73.00
$ o.oo
Building Department
Gopy
Valuation:
Total Sq Feet:
$ o.oo
0 See Permit Record
Fee Ar¡lount
Septic Fee - New
Total:
$73.00
$73.00
2Thursday, August 25, 2011
GarfleÍcll Cc>*¿rt
108 8'h Street, Suite 401, Glenwood Springs, CO 81601
Ph:970-945-82 1 2 Fx:970-384-3440 Inspection Line:888-868-5306
www. garfi eld-countv. com
SEPTIC PERMIT APPLICATION
Lot No: Block No: Subd./Exemption:Lot Size:I Parcel No: (fha rnformaÛb n is available at the assesso¡s otlce 970-945-9134)
2 Job Address: (rTan address has,-ç8{nof been assþned, p lease provide CR, HWY or Street Nane & Crty) or and legal description
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3q os t7Ph:AIt Ph:Mailing Address' /atç t/croê? ¿cpQ4Owner'. þroperty ownefâ¿p_fit ¿GÊâçrtAeæt
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) Alteration RepairPERMIT REQUEST (New nstallation7
I ( )Non- Domestic wastesor industrialWASTE TYPE:
)Other -
Use (
9
t0
11
Was an effort made to connect to the Community System?
DISTANCE TO NEAREST COMMUNIW SEWER
YOU R N DI VI DUAL S EW AG E D SPOSAL SYSTEM PERM IT WI LL N OT BE SSU ED WITH OU T A S ITE P LA N
l2
Depth to '1d Ground Water Table-GROUND CONDITIONS:
Percent Ground Slope-
l3 TYPE OF |NDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS)
0lseptic Tank ( )Aeration Plant (
{ )Recycling, Potable Use ( )Recycling, other use (
PROPOSED:
)Vault ( )Vault Privy
)Pit Privy ( )lncineration Toilet
( )Composting Toilet
( )ChemicalToilet
L4
Will effluent be discharged directly into waters of the state?( )YES ( )Nol5
l6 ÞgRCOmf lOl TEST RESULTI (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
the local health department for purposed of the evaluation of the application; and the
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and additional test and reports as may be required byis conditional upon such further mandatorythat the completeness of the applicationApplicant acknowledges
to be made and furnished by the applicant or bythe local health department
with rules and regulations made, information andto such terms and conditions as deemed necessary to insure complianceissuance of the permit is subject
and conect to the best of my knowledge and beliefto be submitted by the applicant are or will be represented to be truereports submitted herewith and required
the permit applied for herein. I furtherof health in evaluating the same for purposes of issuingand are designed to be relied on by the local department
permit granted based upon said applicationapplication or revocaiion of anyin the denialunderstand that any falsification or misrepresentation
and legal action for perjury as provided by law.
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Fees Paid:
2J
Balance due:Total fees
3
Perk Fee:
E b
Permit Fee:
3
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Issue Date:Septic Permit:
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Building Permit:qJì
Building & Planning Dept:
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