HomeMy WebLinkAboutApplication-Pending195 W. 14' Street _ 2014 Blake Avenue
Rifle, CO 81650 Gr�,� f elf ����IZ�� Glenwood Springs, CO
(970) 625-5200 f L
81601
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PuNic Health (970) 945-6614
ACT 19
''""' `'T OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
12 New Installation ❑ Major Repair ❑ Minor Repair ❑ Alteration ❑ Vault and Haul
BUILDING USAGE TYPE
2 Dw ellinu ❑ Transient Use ❑ ('onim,/Industrial ❑ Non -Domestic
❑ Other Describe
INVOLVED PARTIES
Property Owner: SPENCER CHARLES HOLDINGS Phone; 970
638-i464
Mailing Address: 3892 HIGHWAY 82, GLENWOOD SPRINGS, CO 81601
Email Address: JUSTIN@GO-RENTALS.COM
Contractor: OWNER
Mailing Address:
Email Address:
Engineer: CARLA OSTBERG/CBO INC. F
Mailing Address: 129 CAINS LANE, CARBONDALE, CO 81623
Email Address: CARLA.OSTBERG@GMAIL.COM
PROJECT LOCATION AND DESCRIPTION
Project Address: TBD RAPIDS VIEW LANE
Phone:
ne: n n ) 309-5259
Assessor's Parcel Number: 218104307033 Sub, RAPIDS ON THE CO. Lot 33 Block
Building or Service Type: SINGLE FAMILY RES. #Bedrooms: 4 Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer System: >5 MILES
Was an effort made to connect to the Community Sewer System
Potable Water ❑ Well O Spring ❑ Stream or
Source & Type Creek
NO
❑ Cistern
0 Community Water System Name RAPIDS ON THE COLORADO
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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 necessary to 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 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.
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.
JUSTIN SANFOR€]t—
Property Ownerill and Sign
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
Building
Total Fees:i
Date:
Garfield County Public Health Department:
Signed Approval
10-10-25
Date
Fees Paid: (000
Balance Due:
I
Date
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