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HomeMy WebLinkAboutApplication-PendingGurfield Coun$ Public Heulth 195 w. 14th street Rifle, CO 81650 (970) 62s-s200 2014 Blake Avenue Glenwood Springs, CO 81601 (970) 94s-6614 OWTS PERM IT APPLICATION TYPE OF SYSTEM CONSTRUCTION tr New lnstallation El Alteration tr Repair BUITDING USAGE TYPE A Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic E Other Describe INVOLVED PARTIES Property Owner Kyle Byman 970 618-8538 Mailing 213 County Rd 228 Email Addres5' kylebyman@icloud.com OWNER Phone:o7n 61 8-8538 Mailing Address: Same as above Email Address:Same as above Engineer: Huddleston-Berry Phone:( 970 1 255-8005 Mailing Address:2789 Riverside Pkwy. Grand Junction, CO 81501 Email Addfess' andersonw@huddlestonberry.com PROJECT TOCATION AND DESCRIPTION Job Address:213 County Rd 228 Assessor,s parcel Number. 212531300140 Sub. section 31 rownship: 5 RglqglllLotll Block Building or Service lyps: Residential fBedrooms: 4 Garbage Disposal(Y/N) No Distance to Nearest Community Sewer Syste m: NA Was an effort made to connect to the Community Sewer System:NA Potable Water Source & Type El Well tr Spring E Stream or Creek E Cistern E Community Water Syst€m Name Garfield County Public Health Department - working to promote health and prevent disease CERTIFICATION 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. Kyle Byman 6t18t2025 p-p"*v o* n {Print.nfsign Date Applicant acknowledges that the completeness of the application isconditio.nal .rpo.n such further niandatory and additlonaltests and reports as may be required by the local health department to be made and furnished by the applicant or by the locil health deparfment for purpose of the evaluation of the application; and tlie issudnce of the permit is su.bject to such terms and conditions as deemed neceis'ary to insure compliance with rules and regulations made, information and.reports submitted herewith'and required t6 be submitted by the applicant are or will be represented to be true and correct to the belt 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 any falsification 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. OFFICIAT USE ONLY \ Special conditions *H5b.o'"3'6b .croPermit Fee:Xn@ lssue Date:Balance Due:eOWTS Permit: SFPrr-q3.llq Buildine Permit?ilEqgra Garfield County Public Health Department: Signed Approval Date ir:,', : ii j .i : i,tii,1.,t: I i, 1 ,il I !