HomeMy WebLinkAboutApplicationGurfield Coun$
Public Heulth
195 w. 1-4th street
Rifle, CO 81650
(s70) 62s-s200
2014 Blake Avenue
Glenwood Springs, CO 81601
(s70) 94s-66r4
OWTS PERM IT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
E New lnstallation n Alteration n Repair
BUILDING USAGE TYPE
E Dwelling [] Transient Use n Comm./lndustrial n Non-Domestic
I other Describe
INVOLVED PARTIES
prooertv OWner: LARRY AND suslE BRANNoN FAMILY TRUST PhO ne.( 805 ) Be6-e724
Mailing Address
Email Address:
PO BOX 2834, SANTA MARIA, CA 93547
Contractor: Woodstone lnc. PhOne: ( 970 ) 31s-7s40
Mailing Address
Email Address:
P.o. Box 1038, Carbondale, CO 81623
Engi 6ggy. Sopris Engineering , Paul Rutledge & Yancy Nichol one: (szo ) 704 031 1
Mailing AddfeSS: 502 l\y'ain Street, Suite 43, Carbondale, CO 81623
Email AddfeSS. prutledge@sopriseng.com
PROJECT LOCATION AND DESCRIPTION
Job Address 253 SHORE DRIVE, SILT, CO B1652
ASSeSSOfTS ParCel NUmb l-1.217s12401004 $q!. RIVERVIEW RANCH SUBDIVISIoN LOt a BIOCk
Building or Service Type Residential #Bedrooms: a arbage Disposal(Y/N) no
Distance to Nearest Community SewerSystem > 5 mile
Was an effort made to connect to the Community Sewer System N/A
Potable Water Source
& Type
tr Well tr Spring ! Stream or Creek E Cistern
! Community Water System Name
Garfield County Public Health Department - working to promote health and prevent disease
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liilliEfii'rfi}i.iri:t'fi the applicantoi by u'" iliiil-rli,lit} a';iailnid;ti;ipuin.o.i9 otthe evaluation or
iffi;#ii;'til;iiti":ffii,iJilf ih-i;e*'it'i;rqbiicfib 'iict'
tirmiano'conditions as deemed
necessary to tnsure coriiiiJnii,"tt'h;itdsana'";stl];'tffi m;,G;.inrorrnation and.reports submitted
herewith and reoulred t['[ij.'iu"iiii"o'6i,iiii ii"pii*nf irii or riitit ue rep.resFnted td be true and
correct to the beit of mv knowledge and belief and are deslgned to be relled on oy tne.locar
department of heatth r"L"ii,iiti,Girid'J.mdiir il,i":;;;?iliulire t[e. p.ermlt aRRlied,for herein' I
fuiitrer understand that any falsifiiatlon or misre-presentatlon may result in the denlal of tne
apptication or revocation of any permltBrantJ-bffi;iilFiliiill'ppitcitlon and legal action for periury
as provided by law.
I hereby ac*nowledge that I have read and understand the Notlce and Certlflcatlon above as
well as have provlded the requlred lnformatlon which ls correct and accsrate to the best of
my knowledge.
Owner Prlnt and Sign
Plgc 5 ol'.1
tlp.htrd Drc 20lJ
Spedal Condltions!
Fees Pald:ooTotal Fees:@Fee:@
Permlt:
\
lssue Date:BulldlmPermlt
cartl€ld county Publlc Health Departmentl
Sltned Approval Date
4/16/2025