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 L ❑_ Alteration ❑ Repair
BUILDING USAGE TYPE
® Dwelling 10 Transient Use ❑ Comm./industrial ❑ Non -Domestic
❑ Other Describe
INVOLVED PARTIES
Property Owner: JASON & JAMIE OLDEN Phone:( 303 ) 817 - 9 0 8 0
Mailing Address: 3143 STH STREET BOULDER COLORADO 803D4
Email Address: JASONQSIDFACTOR. COM
Contractor: CRAWFORD DESIGN BUILD LLC Phone: ( 9 7 0) 3 0 9 - 91 S I
Mailing Address: PO BOX 1236, CARBONDALE, COLORADO, 81623
Email Address: CDBSIMON@COMCAST.NET
Engineer: _HIGH COUNTRY ENGINEERING, INC Phone:( 970 ) 94 5- 8 6 7 6
Mailing Address: 1517 BLAKE AVE SUITE 101 GWS CO 81601
Email Address: RNEAL@HCENG . COM
PROJECT LOCATION AND DESCRIPTION
Job Address:. TBD WOODEN DEER ROAD, CARBONDALE , COLORADO B 1623
Assessor's Parcel Number: 239324304005 Sub. WOODEN DEER Lot 5 Block 0
Building or Service Type: OWTS #Bedrooms: 4 Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer System. 1.2 MILES
Was an effort made to connect to the Community Sewer System: NO
Potable Water Source
&Type
❑ Well
ElSpring
❑ Stream or Creek
❑Cistern
II Community Water System Name WOODEN DEER SUBDIVISION
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.
gaze�� oa� 02/10/2021
P operty Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Per Fee:
Total Fe .
Fees Paid:
123
I". Dv
23 •�
Building Permit
owTS Permit:
Issue Date:
Balance Due:
Garfield County Public Health Department:
Signed Approval Date
M.$VV3•DD.s GIG1'L(M