HomeMy WebLinkAbout3406 Upper Cattle Creek Rd - 239122203001 - OWTS-10-13-9818DEPARTMENT OF
ENVIRONMENTAL HEALTH
(970) 328-8755
FAX: (970) 328-8788
TOLL FREE: 800-225-6136
www.eaglecountv.us
EAGLE COUNTY
P.O. Box 179
500 Broadway
Eagle, CO 81631
www.eaglecounty.us
OWTS PERMIT # UU1 T5 1 c 3 ^ Y5'/�[ _ _ BUELDING PERMIT # 14i-,U F -!j - / 3 -- %420�o-t-_
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED (SITE PLAN MUST BE INCLUDED)
FEE SCHEDULE
APPLICATION FEE $800.00 MAJOR REPAIR FEE $800.00 MINOR REPAIR FEE 400.,00
This fee includes the OWTS Permit, Site Evaluation (Percolation Test, or Soil Profile Observation) and Final
Inspection. Additional fees may be charged if a re -inspection is necessary, or a pre -construction site visit or
consultation is needed. The re -inspection fee is $135.00
Make all remittance payable to: Eagle County Treasurer.
Property Owner: s �. �r��T Phone: `7j>0 -9 D- 7 ` 3 ZO j
Mailing Address: _ '� O /0 27 A sa O' KlWem►ail u t abs e h N�
Registered Professional Engineer: Phone:
c.QEi
Applicant or Contact Person: L vw, J Phone:-
sC-
Licensed Systems Contractor:�S License #
Company / DBA: Phone:
Mailing Address: �d %2.x /a 7-7 186al1 C,4 $-/� 2�email
Permit Application is for: New Installation X Alteration
Location of Proposed Onsite Wastewater
Legal Description: '' 5LO 6 U laae-)- c
Repair
L , G t, K4 jA, rlG r Sk 1. LOT (3
Tax Parcel Number: 39f ! , zz_ 3 00 2 Lot Size:
Assessor's Link: www.eaglecountv.us/natie/
Physical Address:
Building Type:
Residential / Multi Family Number of Bedrooms:
Commercial / industrial* Type of Use:
*These systems require design my a Registered Professional Engineer
Type of Water Supply: Private Well Spring Surface Public
If Public Name of Supplier:
Applicant Signature:
Office Use Only
Amount Paid: :-q In
Receipt #: Check #:. Date:
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