HomeMy WebLinkAboutApplication(:Garfield CoantyR
FEB U Development Department
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19701945-82L2
www.garfi eld-countv.com
TYPE OF GRADING
E MAJOR tr MINOR
INVOTVED PARTIES
Property Owner:
Mailing Address:
Caerus Piceance LLC
,
143 Diamond Ave, Parachute, CO 81635
Phone 70 285-2656
EmailAddress:lcl ick@caerusoi landgas.com
Contractor:TLC Pipeline Construction ptrone: (970 ) 285-2069
Mailing Address:2l3Diamond Loop, Parachute, CO 81635
EmailAddress:tlcpi peline@tlcpipeline.com
Architect: Phone: (-)-
Mailing Address:
EmailAddress:
Engineer:Timberline Engineering & Land Survey phone:f435 ) 789-1365
Mailing Address:209 North 300 West Vernal, UT 84078
EmailAddress:msb@timberlinels.com
PROJECT NAME AND LOCATION
Project Name Middle Fork To Williams 16"
Describe Work:Grading of pipeline ROW to install a buried 16-inch, steel, 3 phase gathering line.
The total length of grading is 4,765 feet long and the width is 50 feet wide.
Total area to be graded and reclaimed is 5.17 acres
Job Address:NPM M33 496 well pad. SW 1/4, SW 1/4, Section 33, T4S, R96W, 6th PM
Assessor's Parcel Number:21 3527 3000 1 5, 217 1 0410002 1
Sub Lot _Block
Earthwork (square feet):5.17 Acres Earthwork (Cubic Yards):
GRADING PERMIT
APPLICATION
AtL UTITITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be signed by the
an authorized agent. lf the signature below is not that of the Owner, a
Owner of the property, described above, or
separate letter of authority, signed by the
Owner, must be provided with this Application.
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Void permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is true a nd correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division. ln consideration of the issuance of the Building Permit, lagree that land my agents will comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, OWTS
regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder
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
Aubree Bes VP of Land 0210112024
Owner Print arid Sign Date
A.OFFICIAL USE ONLY ttt#itll'E
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Zoning:lssue Date:
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Grading Permit:
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BUILDING / PLANNING DIVISION :
Date
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