HomeMy WebLinkAboutApplicationRECEIVED
JUL rJ $ ?.il?Ï
GARFIELD COUNTY
cbmuuHtrY DEVELoPMENT
195 W. 14th Street
Rifle, CO 8L650
(970) 62s-s200
Public Heulth
OWTS PERM IT APPLICATION
201"4 Blake Avenue
Glenwood Springs, CO 8160L
(970) 94s-66L4
Gørfield County
TYPE OF SYSTEM CONSTRUCTION
E New lnstallation tr Alteration tr Repair
BUILDING USAGE TYPE
E Dwelling D Transient Use tr Comm./lndustrial tr Non-Domestic
E Other Describe
INVOTVED PARTIES
Property Owng¡¡ BUREAU oF LAND MANAGEMENT Phone:()
Mailing 23OO RIVER FRONTAGE ROAD SILT, CO 81652
Email Address:
Contra TEP Rocky l\rountain LLC ¡ ( 970 1285-e377
Mailing AddfeSS: PO Box 370, Parachute, CO 8'1635
Email Address:KMclntosh@teraep.com / BHotard@teraep.com
Walkèr I 435 ) zAg-rOrz
Mailing AddfeSS: 85 S 200 E Vemal, Utah 84078
EmailAddress:swalker@uintahgroup.com
PROJECT TOCATION AND DESCRIPTION
JOb AddreSS: wMc24-17 Pad
Assessol,s ParCel Numbe¡;2403-06l-00-900 Sub. lsf 6,7,8,e Block
Building or Service Type: small rempomry Emplovee Housins #Bedrooms 7 Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System:NA
Was an effort made to connect to the Commun¡ty Sewer System:NA
Potable Water Source
& Type
E Well tr Spring E Stream or Creek E Cistern
E CommunityWater System NAme C¡tyolRme
Garfield County Public Health Department - working to promote health and prevent disease
Applicant acknowledges that the completeness of the appl¡cat¡on isconditional upon such further
nìandatory and additionaltests 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 a pplication; and the issuance of the permit is subject to such terms and conditions as deemed
neceisãry to iniure 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 belt 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_ perqrit applie.d for herein. I
fuither 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.
CERTIFICATION
I hereby acknowledge that I haye 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.
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Property Owner Print and /ox{
OFFICIAT USE ONLY PAID. $?5ôo e.c. o1/oc/zozz¿þxt-
Special Conditions:
Permit Fee:
$?5 oo
fotal Fees:
$?t, oo
Fees Paid:* 1ç,oe
Building Permh
u/a
OWISPerm¡t:
sePT-1L19
lssue Date:Bal¿nce Due:+ø
Garfield County Public Health lÞpartment:
Signed Approval Date
07/14/2022
07/14/2022