HomeMy WebLinkAbout3408 Upper Cattle Creek Rd - 239122203002 - OWTS-10-13-9821DEPARTMENT OF
ENVIRONMENTAL HEALTH
(970) 328-8755
FAX: (970) 328-8788
TOLL FREE: 800-225-6136
www.eaoiecounty-us
tfiULf COUNTY
P.O. Box 179
500 Broadway
Eagle, CO 81631
www.eaglecounty.us
PERMIT APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM
OWTS PERMIT' # - 11D - I BUILDING PERMIT # _
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 QOd10
This fee includes the OWTS Permit, Site Evaluation (Percolation Test, or Sail 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: 'bo �g IOLS.
L • G"J —r u s Phone:
Mailing Address: O �o �c /0 --7 a-2,11 r3 2'/6 2-1 email
Registered Professional Engineer: Phone:
cA I
Applicant or Contact Person: o ti^ Phone:
NoS, G "s 4-, L.L. C,
Licensed Systems Contractor: Z,. Ixs4 G t-k License #
Company / DBA:
Phone:
Mailing Address: 114 loa> 9015a 1/ CO 9-/6 21 email
Permit Application is for: New Installation Alteration
Location of Proposed Onsite
Legal Description: 3 4 a ,
Repair
Tax Parcel Number: _ 2 3 9/ Z 2 z u. 5 o o z Lot Size: a• -20 / C
Assessor's Link: www,eaglecounty.us/oatie/
Physical Address:
Building Type: Residenlidal / Single Family
Residential / Multi Family
1-oTA
Number of Bedrooms: —1--- 3
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 00
Amount Paid: % Receipt #: Check #: Date:
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