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HomeMy WebLinkAboutApplicationGørfteld County Public Heulth 195 w. l-4th Street Rifle, CO 81650 (s7o) 62s-s200 2014 Blake Avenue Glenwood Springs, CO 81601 (970) s4s-661.4 OWTS PERM IT APPLICATION TYPE OF SYSTEM CONSTRUCTION E New lnstallation I Major Repair I Minor Repair E Alteration E Vault and Haul BUILDING USAGE WPE n Dwelling E Transient Use tr Comm./lndustrial tl Non-Domestic I Other Describe INVOLVED PARTIES Propertyowner: Kate Fratzke Phon e:{ 970 ) 948-0400 Mailing Address 3OB CINDYS WAY RIFLE co 81650 EmaitAddress: katebfratzke@gmail.com Contractor:Albert Harris Phone:( 970 ) 456-9883 Mailing Address: EmailAddress: 3211 237 COUNTY RD,slLT, co 81652 acharrisS4@qmail.com Engin Phone:(970 \625-4344 Mailing Address: Email Address: 0233 County Road 265, Rifle, CO 81650 calibreng i neering@outlook. com PROJECT TOCATION AND DESCRIPTION robAddress: 308 CINDYS WAY. RIFLE, CO 81650 Assessor's Parcel Nu 212733300358 su¡. Antlers Orchard Lot Block Building or Service Type dence Bedrooms: UP tO 2 Garbage Disposal(Y/N) N Distance to Nearest Community Sewer System:Rifle.4 miles Was an effort made to connect to the Community Sewer System:nô Potable Water Source & Type ¡ well n Spring E Stream or Creek [] cistern ! Community Water System Name Garfield County Public Health Department - working to promote health and prevent disease 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 neceésary to ínsure 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. €-z/-zv Property Owner Print and Sign Date Special Conditions: 'i\',ä.æ Fees Paid:Grn .d5Permit Fee lorT)ôo OWTS Permit: 5F-W-R\3r- lssue Date:Balance DIR:+Buildirlg Permit Y+Jlrt-g\3< Garfield County Public Health Department: Signed Approval Date Garfield County Public Health Department - working to promote health and prevent disease 06/27/2023