HomeMy WebLinkAboutpitkin.eh.246515300006 (2007)_NO SEPTIC REQ'D FORMDocument Layout
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Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
itkin Cnnnto 0 0
NO SEPTIC PERMIT REQUIRED FORM
Date: (0, 12c) IO -1
Owner's Name:
Project Name:
Address of Property: 1y o o rd
Building Permit number:
Parcel ID # alc'-1'5--I -1) - nQ--0O�n
Scope of Project:�puak LtrLc�l i I o n Ta -119 L��hr,,) i S
Remodel does not increase the bedroom/potential bedroom count
Existing septic system is sized for this project
New buildings do not need a septic system (i.e. garage, shed, barn, etc.)
Project is not located in the area of the existing septic system
No septic permit is required for this project. No further review is required by
Environmental Health.
FOOD SERVICE FACILITY
This facility contains a retail food establishment. Environmental Health has
reviewed and approved the plans.
10405 Castle Creek Road, Suite 10
(970) 920-5070 fax 920-5077
3
Aspen, Colorado 81611
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PITKIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM
0405 Castle Creek Road, Suite 10, Aspen Colorado 81611
Phone (970) 920-5070 Fax (970) 920-5077
Name of OWNER S
Owners Mailing Address
City, State, Zi Business Phone: foZAY
Home Phone: E-mail Address: O • 2>U. U
Primary Contact Person (all communication regarding this permit will go through this person)
Name CKI5 f�P 12C
Com an 1
Contact Mailing Address
State, Zi s Business Phone
Cell Phone : q70131'7- Fax: 7 E-mail Address: G
Parcel ID # (available from assessor's office /
at 920-5160 or at www.oitkinassessor.org ) � A l6- !—� // - 1
Building Permit # (if available) o o w' 1
Street address of property (goo o -Q�V 4 6p 1
Legal Description: Lot 14_ ,Block ,Filing ,Subdivision rj
Size of lot: ?754 acres. Type of proposed structure: D
Total square feet of house 3 6 q f # of bedrooms (potential) in house
Caretaker Unit: Attached ( ) Detached ( )
Total area(sq. ft.) of caretaker unit # of bedrooms (potential) in caretaker unit
Permit is for. New Home ( ) Repair due to failure ( ) Remodel/Addition ( Vf, Emergency use ( )
Water: Private well ( ✓) Spring ( ) Stream ( ) Community/Public Water System ( )
If community system: Name of system
The fee for a ISDS application is $600 for a permit that takes 6 hours or less for the department to approve. If approval takes
longer than 6 hours, a rate of $100 per hour will be charged. The maximum fee is $1000. The basic fee of $600 is due at the
time of application. The remainder, if any, will be due in two stages: first, at the time of issuance of the ISDS permit; second,
before final approval of the ISDS permit.
Application for an individual sewage disposal system is hereby submitted. i hereby certify that the above information is true and
accurate and that I have provided true and accurate information on locations of all existing and proposed wells, contour
intervals, buildings, property lines, ditches, slopes, waterlines, springs, suction or irrigation lines, drinking water cisterns, drain
tiles, irrigation ditches, lakes, water courses, streams, floodplain, dry gulches, and existing septic systems. I hereby certify that
any such features not shown on attached site map are not present. Issuance of the permit does not imply the approval of any
other permit required for construction pursuant to Pitkin County codes. No construction may be undertaken until all approvals
and permits have been obtained.
vP�
The Pitkin County Environmental Health Department, Pitkin County and employees of these agencies will be held harmless
should the individual sewage disposal system fail or malfunction. The permit to construct is issued on information submitted by
the applicant or his/her representatives. The owner assumes full responsibility in case of failure of the system.
Signature of applicant "- moi' Date
Received by Receipt # Date 1
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Christopher Shipp
& Associates, Inc.
P.O. Box 1o6o
Basalt, CO 81621
970%927-9274
FAX 927-9722
Email: cashipp@comcast.net
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Date: August 28, 2oo6
Revised - Feb. 13, 2007
Revised - March 10, 2007
Revised April 12, 2007
Revised April 25, 2007
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