HomeMy WebLinkAbout03244 f 1`,
i i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 ? 4 4 ' 4
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( 109 8th Street Suite 303 Assessor's Parcel No. • "y
Glenwood Springs, Colorado 81601
Phone (303) 945-8212 ,
It 1 This does not constitute q
" INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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I. R, PROPERTY ? ,,
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s t $;bMt one Sfo�en '7 &ba 43(cl i - Phone 4 —
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r Owner's Neme �J p Q Present Address p (� Phone
System Location ' /r) 0d- COUvi17 ROacQ 3 (9 &i"T'2 Cp 21 6S0 1
4 Legal Description of Assessor's pie No. ' �i 9)&17 / 1 r;
SYSTEM DESIGN r 4 ,s5 ,,t4 vr T/e b „, ve - .''V � 3
,5 . / c d Sepbc Tankk Capacity (gallon) Other — //12/4 n
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¢ /'/ / / /ff / .f / Percolation Rate (minutes /inch) Number of Bedrooms (or othe 7" 1 4, 4 Required Absorption Area - See Attached - .
t t Spa Setback Requirements:
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/ "` ." * Inspector - "' - Ii ✓i/r/ f v,
FINAL SYSTEM IN I�N ADD PF(QV$r'(as installed) .1
• Call l speoil t • u ice Covering Installation c
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System Iler ao% La_ - -- -. - -- v 7
SePtio Ta - A ! t
t' i Septic Tank M` actujer ade.Nerr(e,
p P Tank Ac Ithin"W� u /- ` r ;
• Septic v
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Absorption Area ✓� / ' �_"
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Absorption Area Type and /or MarSuf�Cturer or Trade Nal %,. .Ii // ittsi∎
' r Adequate compliance with County and State regulations/requirements • . )
' Other — '
Date / I nspector 7 // i _../ t/ s
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE '
_CONDITIONS: e. k
�.. 1, All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Arkicle 10 C.R.S. 1973, Revised 1984. ( •
6 i 2. 'Tpis permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con -
i f, necRon to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a - + K
requirement of the permit and cause for both legal action and revocation of the permit. s ',
;' 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material
r variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (8500.00 fine — 8 ■'
t t. months in jail or both).
'' White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER re/pQP_Rr19IP Camp A-hr Id Tad iafire 5 • '
ADDRESS 'Oa _ • .. . • / i' O PHONE S , "0 i L/b! -
CONTRACTOR 0 t J Q r
ADDRESS SA-MP . PHONE ✓Yle
PERMIT REQUEST FOR (X NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY. /
Near what City of Town l t l2 // II Size of Lot 4 / I a e rr
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Legal Description or Address P;P ad-4a p
WASTES TYPE: (V, DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: I' P.a, 40,11 d P,
Number of Bedrooms 7 Number of Persons M
(y Garbage Grinder (/S Automatic Washer ()( Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL (}c); SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /1 `- m i IQS
Was an effort made to connect to the Community System? /6)
A site plan is required to he submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WII,I, NOT RE ISSUED
WITHOUT A SITE PI AN,
GROT NI) CONDITIONS
Depth to first Ground Water Table
Percent Ground Slope
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