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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 Property Owner: Garrett Morris Phone: (g70 ) 216-1112 Mailing Address: P0 Box 454 Parachute Co 81635 Entail Address: gmiustme@aol.com ® New Installation ❑ Alteration 0 Repair BUILDING USAGE TYPE Email Address: Mberry@huddlestonberry.com PROJECT LOCATION AND DESCRIPTION Job Address: 2593 county road 301 Parachute CO 81635 ® Dwelling • Transient Use 240710201001 Sub. Lot Block 7 0 Comm./Industrial Sewer System: miles 0 Non -Domestic 0 Other Describe Potable Water Source & Type M Well 0 Spring 0 Stream or Creek 0 Cistern ❑ Community Water System Name INVOLVED PARTIES Property Owner: Garrett Morris Phone: (g70 ) 216-1112 Mailing Address: P0 Box 454 Parachute Co 81635 Entail Address: gmiustme@aol.com Contractor: Quality Concrete Phone: ( 970 ) 618-3879 Mailing Address: 656 Clubhouse Drive New Castle 81647 Email Address: qualityconcretel1@hotmail com Engineer: Huddleston -berry engineering & testing Ilc Phone: ( 970 ) 255-8005 Mailing Address; 2789 riverside parkway Grand Junction CO 81501 Email Address: Mberry@huddlestonberry.com PROJECT LOCATION AND DESCRIPTION Job Address: 2593 county road 301 Parachute CO 81635 Assessor's Parcel Number; Building or Service Type: Distance to Nearest Community Was an effort made to connect 240710201001 Sub. Lot Block modular Home #Bedrooms: 3 Garbage Disposal(Y/N) N Sewer System: miles to the Community Sewer System: No Potable Water Source & Type M Well 0 Spring 0 Stream or Creek 0 Cistern ❑ Community Water System Name 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. Property Owner Print and Sign Date OFFIGOA. USE DNL.Y Special Conditions: Pe mit Fee: 123.00 Tottal Fees: 123.0D FeesPl.d: 17-3.00 Building Permit RId *' b4AV DINTS Permit: 597r-- 01(2 Issue Date: 1O/07/2O2O Balance Due: !.,( /` Garfield County Public Health „ Department: `f' `" t":,.e / .7 _`" ` rZ-1: cl e,e rc`r Signed Approval 1 Date 9),.aDl Cts IRO Page 5 of 3 Updated Dec 2013