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HomeMy WebLinkAboutApplication195 W,14th Street RIBe, CO 81650 (970) 625-5200 Public Health 2014 Blake Avenue Glenwood Springs, CO 81601 (970) 945-6614 OWTS PERMIT APPLICATION -'TYPE or SYSTEM CONSTRUCTION — ❑ New Installation 1 ® Alteration (Review/Inspectit) 0 Repair BUILDING USAGE TYPE --1 Dwelling T I© Transient Use 1 ❑ Comm./industrial 1 0 fon-Domestic ❑'Other Describe INVOLVED PARTIES y_ .. Franklin Property Owner: n Glenwood Springs II LL Phone: ( 970 ) 274-3223 Mailing Address: EmallAddress: mikegoscha@gmail.com Contractor. Clayton Haines Phone: (070 ) 245.9039 MailingAddrers: 671 23 Road Grand Junclion, CO 61505 Email Address: davld.mah°vsky@claytonhomes.eam Engineer: Ken Bretsky Phone: ( 970 216-8861 Mailing Address: Email Address:. kbrolsky@yahoo.cem PROJECT LOCATION AND DESCRIPTION Job Address: 1877 Canyon Creek Rd Glenwood Springs, CO 81601 — Assessor's Parte[ Number: 212323200064 Sub, Lot Block Building or Service Type: Single Family Residence Illiedroams: 3 Garbage D1sposat(Y/N) N Distance to Nearest Community Sewer System:: several miles Was an effort made to connectto the Community Sewer System; N° Potable Water Source & Type IR) Weil . 0 Spring r El Stream or Creek 1 0 Cistern E. l _ 0 Community Water System Neme Garfield County Public Health Department — working to promote heath and prrvtnt diuoase ,,. FICATION _ •' , : lip *.. 1•-�:.r� a4j:i,Rj�C.'li.;`;�,- .. °:�C.?_;.:�}ri-',e}t�,.�F�t pis �.i.'.� 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 Iocal health department to be made and furnished by the applicant or by the local health department for purpose of the eveluatlon 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 Iocal department of health In evaluating the same for purposes of issuing the permit applied for herein. 1 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 bylaw. t hereby acknowledge that I have reed and understand the Notice and Certification above es well as have provided the required Information which Is correct and accurate to the best of my knowledge. G/ a t 2 / C/zo Property Owner Print and Sips Date SOFfIC c• ik.:: t : 5: Spoda1 condit10nzi c)(S---:e`sC';--,k --;36\-(.,,,-,TC.V'l CSC_s5rVv2VV -T7, ��(c,:lciar �C( plc -0'46 g 1101.4. .--S (O ec L n rt PeniftcTotal $ • bD trasT . 00 Fees Paid: e Building remit ?IMF- Lig owrsParmtt; S-_ Iaw:9/23/2020 Balance Due: jiff Darned County Pubic tt.Nte, Department: 414.._ . ii.a�a3 / o A� • ' Date X5:00, ✓#SZbTr7e4 23 17/67-0 Page 5 of 3 Updated DicaaI3