HomeMy WebLinkAboutApplication-Pending195 W.14`h Street 2014 Blake Avenue
Rifle, CO 81650 Garfield County Glenwood Springs, CO
(970)625-5200 81601
AC Public ,wealth (970) 945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
m New Installation
BUILDING USAGE TYPE
❑ Major Repair , ❑ Minor Repair I ❑ Alteration I ❑ Vault and Haul
m Dwelling I ❑ Transient Use I ❑ Comm./Industrial I ❑ Non -Domestic
I10ther Describe Comm unity Gathering Space I
INVOLVED PARTIES
Property Owner: Aspen Valley Land Trust Phone: (970 )456-3560
Mailing Address:320 Main St Suite 204 Carbondale, Co. 81623
Email Address: Jeff@avlt.org
Contractor: RMB Excavation LLC
Mailing Address: P.O. Box 998 Carbondale, Co. 81623
Email Address: office@rmbexcavation.com
Phone: ( 970) sia-Zios
Engineer: Crvstal River Civil LLCy�r� I Phone: 970
'Mailing Address: 1101. Village Road, Unit OL-3C Carbondale, Co. 81623
Email Address: jay@crystalrivercivil.com
PROJECT LOCATION AND DESCRIPTION
10-5312
Project Address: 1837 Countv Road 100 Carbondale, Co. 81621
Assessor's Parcel Number: 2393-363-21-001 Sub, Doug Coffman Lot 1 Block
Building or Service Type: Septic #Bedrooms: NSA Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System:Several Miles
Was an effort made to connect to the Community Sewer System:
Potable Water
Source & Type
0 Well ❑ Spring I ❑ Stream or
Creek
❑ Community Water System Name _
❑ Cistern
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
urther mandatory and additional tests and reports as may be required by the local health
epartment to be made and furnished by the applicant or by the local health department for
urpose of the evaluation of the application; and the issuance of the permit is subject to such
arms and conditions as deemed necessary to insure compliance with rules and regulations
lade, information and reports submitted herewith and required to be submitted by the
pplicant are or will be represented to be true and correct to the best of my knowledge and
elief and are designed to be relied on by the local department of health in evaluating the same
)r purposes of issuing the permit applied for herein. I further understand that any falsification
r misrepresentation may result in the denial of the application or revocation of any permit
ranted 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.
Torrey Udall
Property Owner Print and Sign
February 27 2026
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee: (`jQ
Total Fees:(,,,, CO
Fees Paid: cc
Building Permit-T�
OWTS Permit:
Issue Date:
Balance Due:
Garfield County Public Health Department:
Signed Approval Date
Garfield County Public Health Department — working to promote health and prevent disease