HomeMy WebLinkAboutApplicationGarfield County INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
(tsDs)
PERMIT APPTICATION
Community Development Department
108 8tn Street, suite 401
Glenwood Springs, CO 81601
l970l94s-82L2
www.ga rfiel d-cou ntv.com
TYPE OF CONSTRUCTION
E New lnstallation tr Alteration trRe tr
WASTE WPE
tr Dwelli E Transient Use E Comm/lndustrial Non-Domestic
E Other Describe
INVOLVED PARTIES
Mailing Address: 1676 County Road 100
Property Owner:Dale Eu Phone: (970 ) 963-4500LLC
Contractor: Travis Hughes
Mailing Address
Phone: (970 )
PROJECT NAME AND LOCATION
963-9869Engi¡ss¡¡ Timberline Engineering, LLD
Mailing Address PO Box 842, Carbondale Colorado 81623
Phone:970
E SepticTank E Aerat¡on Plant E Vault tr Composting Toilet
E Recycling tr P¡t Pr¡w E lncineration To¡letE Recycling, Potable Use
E OtherE Chemical Toilet
Was an effort made to connect to the Community Sewer System
Distance to Nearest Community Sewer System : +1 Mile
Ç¡l b.
Building or Service Type:Warehouses M office
:No
100- Carbondale. Colorado. 81623Job Address:
239336300014Assessoy's Parcel Number:
E Vault PrivyType of ISDS
Lot Block
#Bedrooms:Garbage Grinder _
Depth to 1" Ground water table +9'Percent Ground Slope 5o/o-1Oo/oGround Conditions
El Absorption trench, Bed or Pit E Underground Dispersal E Above Ground Dispersal
E Evapotranspiration E Wastewater Pond E Sand Filter
Final Disposal by
E Other
Water Source & Type E cistern
E Community water System Name
Effluent Will Effluent be discharged directly ¡nto waters of the State? E Yes E No
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
"iänOiiow and addiiional test and reþorts a.s Tay be required by the local health de.partment to be
rããã ànOîurnished bv the applicant br by the local health department for purposed of the evaluation
ófiñã áppl¡.ation; and the isiuance of the permit is. su.bject to such terms and conditions as deemed
ñeèãrsãiy to insuie compliance with rules ánd regu.lations made,.information and.reports submitted
trãiã*¡itr'and required tò be submitted by the -apþlicant are or will b.e rep.res.ented to be true and
Córrect to the beit of my knowledge and belief and are designed to be relied on by the.local
ãápJrtr"nt of health in'evaluatin[ the same for purposes of issuing the. permit applied for herein. I
tuïñei understand that any falsifiıation or misreþresentation m.ay result in the denial of the
rlpii..tion or revocation of any permit granted based upon said application and legal action for perjury
as provided by law.
I
h
acknowledge that I have read and understand the Notice and Certification above as well as
the u which is and accurate to the best of kn
rty Owner Print and Date
lv7.oo,lf??ft, t"lrl t1
OFFICIAL USE ONLY
Special Conditions:
Fees Pa¡d:lz -
Total Fees:lL4 -Perk Fee:
ENA ,
Permit Fee:lLh-
Balance Due:lssue
BLDG DIV:
0 %
DATE