HomeMy WebLinkAboutApplicationGarfield Coun$
Public Heulth
195 W. 14th Street
Rifle, CO 81650
(970) 52s-s200
2014 Blake Avenue
Glenwood Springs, CO 81601
(s7ol94s-6614
OWTS PERM IT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
K New lnstallation E Major Repair E Minor Repair E Alteration E Vault and Haul
BUILDING USAGE TYPE
E Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic
E Other Describe
INVOTVED PARTIES
propertyowngs; Eliecer Miramontes Gonzalez Phone:19tU 1 4U5-4Jb/
MailingAddress: Box 2313 Glenwood Springs, CO 81602
Email Address: eli@highprofileroofing.com
ualenta uonsructron 1 9/0 1 4U4-AJAZ
Mailing Address:144 Cliffroad Way Glenwood Springs, CO 81601
EmailAddress: uriel.mellin@hotmail.com
tsounoanes unlrmrleo, lnc.( 970 t 945-5252
Mailing Address:
Email Address:
923 Cooper Avenue Suite 201 Glenwood Springs, CO 80601
bruce@bu-inc.com
PROJECT TOCATION AND DESCRIPTION
Job Address:2225 Midland Avenue Glenwood Sprin qs, GO 81601
Assessor's Parcel Number: Sub. Lot Block
Building or service 1r0", Residental *Bedrooms: 4 Garbage Disposal(Y/N) J-
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Potable Water Source
& Type
tr Well tr Spring E Stream or Creek E Cistern
X Community Water System Name urty oI ulenwooo
Garfield County Public Health Department - working to promote health and prevent disease
Applicant acknowledges that the completeness of the application is conditional .rPo.n such further
niandatory and additional tests and reports as may be required by the local health de-partment to be
made and furnished by the applicant oi by the local health department for purpose of the evaluation of
the application; and the issuince of the permit is subject to such terms and conditions as deemed
neceis'ary to insure compliance with rules and regulations made, information and_reports submitted
herewith-and required t6 be submitted by the applicant are or will be represented to be true and
correct to the bebt 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 a.pplied fpr herein. I
further understand that anyfalsifiiation or misrepresentation may result in the denialof 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.
Eliecer Miramontes Gonzales 1t19t24
Property Owner Print and Sign Date
Special Conditions:
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Total Fees:@lffiFees Paid:Permit Fee:(m.@
Balance Due:
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OWTS Permit:
SE{)T-gqqR
lssue Date:Building Permit
Garfield County Public Health Department:
Signed Approval Date
Garfield County Public Health Department - working to promote health and prevent disease
2/12/2024