HomeMy WebLinkAbout454 Casteel Creek Rd - 210519405001 - 1878-99IS VOIDIncomplete Applications Will NOT Be Accepted
(Site Plan NfIST be attached)
ISDS Permit #
Building Permit #
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE-- EAGLE COUNTY-
P. 0. BOX 179
EAGLE, CO 81631
328-8755/927-3823 (El Jebel)
* PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $200.00
*
*
* MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
PROPERTY OWNER:
MAILING ADDRESS.: � d� W I c Va, e73�1gIr►'1 T}') du ST`d ti t X, PHONE:
U Z�
APPLICANT/CONTACT PERSON: `��S» v Iyr :- � PHONE: �
LICENSED SYSTEMS CONTRACTOR: �T'
PHONE: Z. -- -24v�
COMPANY/DBA : 1 jZ L=X i Au.AT 1 P(-z-- ADDRESS: I ` f,
PERMIT APPLICATION IS FOR: (K) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description: not'i toU rAPCHy/A-Z c mil A
Tax Parcel Number: 1 cam'- I T4 bS - 100 1 pLot Size: _S
Physical Address: Q '`z �} CA � � �`r�X 1� 41
BUILDING TYPE: (Check applicable category)
( ) Residential/Single Family Number of Bedrooms _
( ) Residential/Multi-Family* Number of Bedrooms
( ) Commercial./Industrial* Typed
TYPE OF WATER SUPPLY: (Check applicable category)
(?() Well ( ) Spring ( ) Surface
( ) Public Name of Supplier:
*These systems
,Qrequire
�design by ,a/Registered Professional Engineer
SIGNATURE: �U�11r�-`1 1 ► / �r""u �� 0 X4 Date:
AMOUNT PAID: RECEIPT
CHECK #:
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#$ : ` DATE:
/ CASHIER: Lr
1878-99 Tax# 2105-194-US-UU1
Parcel A, Donlon Ranch DORN
JOB- NAME 0454 Casteel Creek Rd.
Edwards
B LOCATION
JOB NO,
BILL TO
DATE STARTED
DATE OM LE ED
DATE BILLED
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JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
JOB FOLDER Product 277 JOB FOLDER Printed In U.SA
