HomeMy WebLinkAbout1520 Red Sky Rd - 19412130201407/26/2012 12:17
9707548459
HOLLAND CREEK
PAGE 01/01
DEPARTMENT OF
OMRONMENTAL HEALTH
(970) 32"755
FAX: (970) 328.8788
TOLL FREE: 800-225-6136
vwuw.aaalecountv.us
P.O.6V 179
5W Broadway
Faple, CO 81631
www.eaOecounty.us
EAGLE COUNTY
PERMIT' PP ICAMW earrE WASTEWATER TREATMENTS
OWTS PEltlrl' # BUILDING PERMIT #
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED (SITE PLAN MUST BE INCLUDED)
FEESCREDULE
APPLICATION FEE S0.00 MAJOR REPAIR FEE SM.00 MINOR REPAIR FEE 4� �O&
This fee includes the OWTS Permit, Site Evaluation (Percolation Test, or Soil Profile Observation) and Final
Inspection. Additional fees they be charged if a re -inspection is necessary, or a pre -construction site visit or
consultation is needed. The minspection fee is $1
Make all readuspee payable to: Eagle County Treasurer.Property Owner: 1zSSY Pro ��� ( L C prone.
Mailing Address: email
Registered Professional Engineer: !o#" K«tl4 4 one: W°(� 58'!
Applicant or ContactPerson• L>c"1 Ne l t Phone: R '70 33 1 4 o S -f-
Licenssed Systems Contractor:. 30lr wk,*U Licew # dam- 'of- ► Z
Company / DBA: ��.r� S�spN1e�r+�e,ra- [ Phone: _
Mailing Address: 06)( 17 7 7 Steps,.►+` %
1 -7 40 - To 4-- 01 F/
Pert wt Application is for: New Installation Alteration A Repair
Location of Proposed OnAte Wastewater Treatment 5yst
Legal Description: iTzo gF-0 SvcY Ea 4b - XCAVAre- + w0fIX- c1ple f
Tax Parcel Number: t T Y l Z l 3 a Z o 1'( L,ot Size -
Assessor's Link: www.eaalecouinty.uatiei
Physical Address: t S 2 0 /ZED S� R0,4 p i GOT 71
Building 1'yl►e: �- Residential / Single Family Number of Bedrooms.
Residential / Multi Family Number of Bedrooms:
C aunerdal / Xadutsdrial* Type of Use.
*These systems require design my a Registered Professional Engineer
Type of Water Supply:
If Public Name of Supplier:
Private Well Spring
1/011181 Grelr-(--
Surface K Public
Applicant Signature-
Office Use Only , f �o v%
Amount Paid: `'; Receipt #; Check #: Date-
08/01/2012 10:58 9707548459 HOLLAND CREEK PAGE 01101
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