HomeMy WebLinkAboutHomestake Creek Rd Lot 1C - 237707200014111`:V1LLLiJ4.0 L.0 (Site Plan &LvvjL.Lt;auJ.un5 n3..L1 ivVT -be Acceptea MUST be attached) ISDS Permit ## _ Building Permit APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY P. O. BOX 179 EAGLE, CO 81631 Eagle (970)328-8755, Fax (970)328-0349, El Jebel (970)927-3823 * FEE SCHEDULE * APPLICATION FEE $350.00 * THIS FEE INCLUDES THE ISDS PERMIT, SITE EVALUATION (PERCOLATION TEST, * SOIL PROFILE OBSERVATION) AND FINAL INSPECTION * ADDITIONAL FEES MAY BE CHARGED IF A REINSPECTION IS NECESSARY, OR A * PRE -CONSTRUCTION SITE VISIT OR CONSULTATION IS NEEDED * REINSPECTION FEE $47.00, PRE -CONSTRUCTION SITE VISIT FEE $85.00 * MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER" PROPERTY OWNER: RA d reco 14, 0/ksfroen MAILING ADDRESS: J ©, 0, Sox -7i 11 4y_ov), Co Z I �ZO PHONE :&80 S I®-Zg_3 APPLICANT/CONTACT PERSON: AlcireL') #. ta,*5�rc "n PHONE: LICENSED SYSTEMS CONTRACTOR: PHONE: COMPANY/DBA: ADDRESS: PERMIT APPLICATION IS FOR: (/N NEW INSTALLATION ( ) ALTERATION ( 1 RF.PATR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Legal Description: /5�00 goines�ake led, Loy' / if Tax Parcel Number:-%� 0�� �%'�r®N Lot Size: ficlPhysical Address: /S� f401Y)0 vike , C; fee ,:, PLOCQI`�P, 61—j 0 I �Ll? BUILDING TYPE: (Check applicable category) (>4a Residential/Single Family ( ) Residential/Multi-Family* ( ) Commercial/Industrial* Numb e r Number Type _ of Bedrooms 3 of Bedrooms *These systems require design by a Registered Professional Engineer TYPE OF WATER SUPPLY: (Check applicable category) ( Well ( ) Spring ( ) Surface ( ) Public Name ofsSuppli,�--r,OL' APPLICANT SIGNATURE: Date: % ��©4F AMOUNT PAID:RECEIPT #: c� vU DATE: (� O CHECK #: ti CASHIER: 'ta,�- —i 6 Ise- c rr31_e__- `F l� �- % to --a a zq 3'rnr�`s fb L jqcj Wit les �r�orn 4,lVlwc,v,zq On Hoene&�otke & - Ray Merry refund _ Page 1 From: Ray Merry To: Brenda Wright Date: 1 /3/03 9:55AM Subject: refund Please issue a $350.00 refund check to: Andrew Wikstrom P.O. Box 7711 Avon, CO 81620 Thanks for your help yesterday! 2243-02 Tax #2377-072-00-014 JOB NAME_ Lot #IC, Homestake, WIKSTRO.K \/�k� JOB NO. 1500 Homestake Rd., Redcliff JOB LOCATION BILL TO DATE STARTED ^^ DATE COMPLETED DATE BILLED ��k e rIe L D5E' �f JOB, COST SUMMARY - - .0 ��•�h}{-,4 dam'?-,-y 1 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 FOIDER Product 278 JOB FOLDER Printed In US.A.