HomeMy WebLinkAboutApplicationGarfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
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Community Development Department
108 8th Street, Sulte 401
Glenwood Springs, CO 81601
(970194s-8212
www.garfield-cou nW.com
WPE OF CONSTRUCTION
E New lnstallation tl Alteration tr Repair
WASTE TYPE
tr Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic
EI other Describe
INVOTVED PARTIES
Property OWngf: Minasian, Ja8on & Christina Phone:
Mailing AddfeSS: 4724 NORTH 252s WCEDAR CITY, UT 8a721
EmailAddress:iasonl minasian @omail.com
Contractor:Phone: ( )
Mailing Address
EmailAddress:
Engineer:Curtis Bockel PhOne: ((s701241'7P76
Mailing AddfeSS: 2516 E For$ight Cir #1, Grand Junction, CO 81505
Email AddfeSS: clb@westwaterco.com
PROIECT NAME AND TOCATION
Job Address:To Be Dotermined Rapids Mew Lane, CO 8'1647
ASSeSSOTTS ParCel NUmber: 2181-u3-07-021 SUb. Rafids on the Colorado Lot 2r Block
Building or Service Type:Single Family Residence fBedrooms: 3 Garbage Disposal(Y/Nl-
Distance to Nearest Community Sewer System:>400 leot
Was an effort made to connect to the Community Sewer System:No
Type of OWTS f, SeptlcTank El Aeratlon Plant E vault E Vault PriW f] ComOostingToilet
E Recycllng, Potable Use E Recacling E pit privy E lnclneratlon Toilet
E Chemical Tollet E other
Ground Conditions Depth to 1d Ground water table Greater than I lset Percent Ground Slope 1,7
FinalDisposalby E Absorptlon trench, Bed or Plt E Undetground Dispersal E AboveGround Dispersal
E Evapotranspiratlon E Wastewater Pond El Sand Filter
E other
Water Source & Type tr wel E Spring E Stream or Creek E cistern
E Community Water System Name APPIo Trs€ PaIk
Effluent Wlll Effluent be dlscharged dlrectly into waters of the State? E Yes E tto
I
CERTIFICATION
it#i.i1,^?:1{fyJ:flffiii*11"^:",T51ffi::?:l'#,,lttiisi'Blii:il3:1'f,131*HofJo"liL:xfiiteffi1il]ffiiilH:;fiffiil'pii;;;i5i uv ine loiai healih department for pu.rposed of the evaluation
of the apptication; .no't-r.rf iiilinie of thei ieimit is subject to such terms ahd ionditions as deemed
necessary to insure cJniiirianie *ith rules i1u iegulitio-ns made, information and reports submitted
herewith and require"ji5'i,d'iJt*iiiil btiil-a-n"ntrcJnt are or rrriitt ue represented to be true and
;;;;";fi;]h; udri oii"Vino-*tdA;-;^d betiirino are designed to be relied on bv the local
;il;ffiili oinJirirr in evatuating tne sameioipurposes oTissuing the.permit apRlied for herein. I
f;Ih;'ft;;;;Aiili i"v t"rilti"c.tion or misrepre'sentation mav resuli in the denial of the
apptication o,. ,"uo..iio*;;i;;t ilimit eriniid d.-seo upon said dpplication 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
rleguired
ttfiaa
Propefi Owner Print and Sign
accurate to the bes! of ryrY knowledge.{ //7/}fisand
Date
6(ldOFFICIAL USE ON
Speclal Conditions:
Paid:6'0Fees
fr
Total Fees:c0$tuen
Perk Fee:Permlt Fee:
$ (d,().c-r}
Balance Due:qfi"*lssue Date:Septic Permit:
Strffi-Q2s_rEuilding Permlt
BUILDING/ PLANNING DIVISION:
Slgned Approval Date
07/03/2025
07/03/2025