HomeMy WebLinkAboutApplicationGnrfield Coun$
Public Health 2014 BlakeAvenue
Glenwood Springs, CO 81601
(97Ols4s-66L4
195 w. 141h street
Rifle, CO 81650
(970) 62s-s2oo
OWTS PERMITAP PLICATION
Property
Mailing *ll
Email Address:
MailingAddress:
Email Address:
Maillng Addresr:
Email Address:
lob Address:
Assessorrs Parcel Number: lgt"4ilfWWl'$tb. Lot Elock
Building or Service Disposal(Y/Nl NA
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Communlry Sewer System:
E Community Water System Name
TYPE OF SYSTEM CONSTRUCTION
Vault and HaulD Alterationfl MinortrNew lnstallation
BUILDING USAGETYPE
Non-Domestictr €omm./lndustrialDwellingTransient Use
Elother Describe
tr Cistemtr Spring ftstream or Creektr WellPotable Water Source
&Type
PROJECT TOCATION AilD DESCRIPTION
TNVOLVED PARTIES It
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Garfield County Public Health Department - working to promote health and prevent disease
CEf,TFK/|TION
hereby thrt I and underttrnd the ilotl(e and Certltlcation abol€ at
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Prop€rty Owner Date
OFFKIAT
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Garfield county Public Health Deparlment - working to promote health and prevent disease
4/10/2025