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HomeMy WebLinkAboutApplication195 W. 14th Street Rifle, CO 81650 (970) 625-5200 Garfield County Public Health 2014 Blake Avenue Glenwood Springs, CO 81601 (970) 945-6614 OWTS PERMIT APPLICATION TYPE OF SYSTEM CONSTRUCTION ❑ New Installation BUILDING USAGE TYPE 0 Dwelling ❑ Other Describe ❑ Alteration ® Repair ❑ Transient Use ❑ Comm./Industrial ❑ Non -Domestic INVOLVED PARTIES Property Owner: Matt and Sarah Cove Mailing Address: 109 Oakland Knoll Glenwood Springs, CO 81601 Email Address: matt.cova@gmail.com Phone: (530 ) 306-7265 Contractor: E&L Excavation Mailing Address: 279 Chair Bar Road Silt, CO 81652 Email Address: eandlexcavation@aol.com Phone: (970 ) 309-3057 Engineer: Roger Neal Mailing Address: 1517 Blake Ave. Glenwood Springs, CO 81601 Email Address: rneal©hceng.com Phone: ( D70 ) 945-9676 PROJECT LOCATION AND DESCRIPTION Job Address: 109 Oakland Knoll Glenwood Springs, GO 61601 Assessor's Parcel Number: Sub. Lot Block Building or Service Type: Dwelling #Bedrooms: 5 Garbage Disposal{Y/N) Y Distance to Nearest Community Sewer System: ? Was an effort made to connect to the Community Sewer System: No Potable Water Source & Type ❑ Well 0 Spring 0 Stream or Creek 0 Cistern la Community Water System Name Oak Meadows Water Association Garfield County Public Health Department — working to promote health and prevent disease CERTIFICATION Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional tests 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 purpose 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. k�Leur Cev-C- Property Owner Print and Sign OFFICIAL USE ONLY Special Conditions: Permit Fee: $75.00 05/14/2020 Total Fees: $75.00 Date Fees Paid: $75.00 Building Permit OWTS Permit: SEPT-05-20-6275 Garfield County Public Health Department: Issue Date: 5/21/2020 Balance Due: $0.00 5igned`Approval Date PD. $75.00, CC, 5/18/2020 Page 5 of3 I'pctated Dec 2013