HomeMy WebLinkAboutApplication-PendingGarfield County
Public Heulth
195 w. L4th street
Rifle, CO 81650
(970) 62s-s200
201"4 Blake Avenue
Glenwood Springs, CO 81601
(970l,94s-66r4
OWTS PERM IT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
tr New lnstallation E Major Repair E Minor Repair U\ Alteration E Vault and Haul
BUITDING USAGE WPE
tr Dwelling E Transient Use V Comm./lndustrial tr Non-Domestic
E Other Describe
INVOIVED PARTIES
Property COKE OVENS 2 LLC I 97O | 4042224
MailingAddrg55; 110 OAK LANE' GLENWOOD SPRINGS' CO 81601
Email Address; ERNESTO@CUCCONSTRUCTION.COM
CUC CONSTRUCTION I ozn | 4042224
Mailing Address: SAMEASABOVE
Email Address: SAME AS ABOVE
Engineen Phone:( 970 19455252
Mailing Address:923 COOPER AVENUE, #201, GLENWOOD SPRINGS, CO 81601
Email Address:DERIC@BU-INC.COM
PROJECT TOCATION AND DESCRIPTION
Job Address:625 AIRPORT ROAD
Assessor,s Parcel Numbe1218527100054 Sub. NONE Lot NE 2 Block
Building or Service Type: CoMMERCIAL #Bedrooms:0 Ga rbage Disposal(Y/N) No
Distance to Nearest Community Sewer System:>2 MILES
Was an effort made to connect to the Community Sewer System:NO, EXISTING STRUCTURE
Potable Water Source
& Type
tr Well E Spring E Stream or Creek 0 Cistern
E Community Water System Name
Garfield County Public Health Department - working to promote health and prevent disease
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additional tests 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 purpose of the evaluation of
the application; and the issuance of the permit is subject to such terms and conditions as deemed
necessaryto 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
further understand that anyfalsification or misrepresentation may result in the denialof the
application or revocation of any permitgranted based upon said application and legalaction 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.
GrLtzb Ctto Grcatza2s
Property Owner Print and Sign Date
OFFICIAL USE ONIY 7-t
Special Conditions:
Fecs Paid:@2crtPcrmit FccA(n Qo
Total Fccs:
Qcr-t oe
Buildine PermitBtlrl -ffi1et
OWTS Permit: '
sE$r[-.q44A
lssue Date:Balance Due:
^(>-'
Garfield County Public Health Department:
Signed Approval Date
Garfield County Public Health Department - working to promote health and prevent disease