HomeMy WebLinkAboutApplication-PendingGarfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATIONApH u I tlJ./b
Community Development Depa rtment
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82L2
www. garfield-countv.com
Alteration
TYPE OF CONSTRUCTION
New lnstallation tr Repair
WASTE WPE
tr Dwelling E Transient Use Comm./lndustrialtr Non-Domestictr
El other Describe
INVOIVED PARTIES
Property Owner: Burkett, Bobby R & Robin G Phone: (rl9_)379-4609
Mailing AddreSS: P.O. Box 184 New Castle Colorado 81647
Email Addresst alltecbob@gmail.com
COntfaCtOr: BobbY Burkett Phone: P7o ) 37e-460e
Mailing Address: P.O. Box 184 New Castle Colorado 81647
Email Address: alltecbob@gmail.com
Engineer:SGM Phone: (e7o ) 384-eoo5
Mailing AddreSS: 118 W. Sixeth St. Suite 200 Glenwood Springs, Co 81601
Email Address:Jeffs@sgm-inc.com
PROJECT NAME AND TOCATION
Job Address:
ASSeSSOT,S ParCel NUmbg;. Section:36Township:5Ran15qb. Antlers Orchard Development [Ot I BIOCk
Building or Service Type g Residential #Bedrooms: 4 Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer Syste m: Mo
Type of OWTS E SepticTank E Aeration Plant E vault E vault Privy ! ComnostingToilet
E Recycling, Potable Use E Recycling E eit erivy E lncineration Toilet
E chemical Toilet E other
Ground Conditions Depth to l't Ground water table Percent Ground Slope
Final Disposalby E Absorption trench, Bed or Pit E Underground Dispersal E Above Ground Dispersal
E Evapotranspiration E Wastewater Pond E Sand Filter
E other
Water Source & Type tr well E Spring E stream or Creek E cistern
E Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? El Yes E lrto
Applicant acknowledges that the completeness of the application is conditional upon such further
niandatory and additional test 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 purposed of the evaluation
of the application; and the issuance of the permit is subject to such terms and conditions as deemed
necessaiy 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
fulther understand that any falsifiiation 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.
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Property Owner Print and Sign Date
Special Conditions:
'ffioo *"%.ooP*nli)
Qo
lssue Date:Balance Due:UBuildine PermitkArr--\tW Seotic Permit:{rPT4rt?-
BU!LDING/ PLANNING DIVISION
Signed Approval Date