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HomeMy WebLinkAboutpitkin.eh.264322301024 (2015)_OWTS CONST PERMIT APPL�II� .jNSITE WASTEWATER TREATME, _ . SYSTEM (OWTS) EI-I,NR 4 CONSTRUCTION PERMIT APPLICATION ' 76 Service Center Rd - Aspen, CO • 81611 Phone: 970.920.5070 Fax: 970.920.5374 19n V19 Parcel ID# (available from the Pitkin County Assessor's Office 970-920-5160 or at www.piLkinassessor.org): l�L 7 -7, Purpose of Permit: ❑ NEW P REPAIR DUE TO FAILURE ❑ REMODEL/ADDITION ,TANK ONLY ❑ FIELD ONLY Cost of System Repair or Remodel/Addition (approximate): Property Address: Lot: Block: Filing: s bdjvi ion: /I --A ( V� ! 'v A, 4umec, Property Owner(s)': Email Address: ����/6l✓'t �P I � �ohvt2el��' C�IVICg5 ,�'Jt'' Owner's Mailing Address I o 7,2;-z City, State, Zip: Co Home Phone: Business Phone: cell `770- 37`1- -W2-L 'Contact information must be provided for the owner sionina this apolication Primary Contact Person/Acant (if not owner): liV1 7 vAnc rz Company: i' I�Gf A% oG Contact/Applicant Mailing Address: 10 ► t ay- - Avg City, State, Zip: co bxv) 0twocA. Cell Phone:q 1 0 F , :' A-1 Business Phone: �'� O �Q . �7pe Fax Number: ��©. 4�• i2 Email Address: , e)►Ma✓e Building Permit # (if applicable): Lot Size (in acres): Size of Building (square feet): Number of Potential Bedrooms: Detached Accessory Unit? ❑ YES ❑ NO Size of Accessory Unit (square feet): Number of Potential Bedrooms In or Fixture List for the Accessory Unit: Water Source: ❑ PRIVATE WELL ❑ SURFACE WATER ❑ SPRING COMMUNITY/PUBLIC WATER SYSTEM Name of Community/Public Water System (if applicable): , r 1� t ,( Jvc) Engineering Firm: 1 � ob Number: Phone Number: Fax Number: 1r� q'76- W4 -S s7&0 Mailing Address: City, State, Zip: to// —6 rrand A✓� 61 1 rr. c&d 5ro . C c, 0 I o ) PLEASE READ BEFORE SIGNING: I certify that the above information is complete and accurate and that I have provided complete and accurate information in all of the documents included in my application package. I acknowledge that EH/NR may revoke any permit I am issued if my application is found to contain any inaccurate, false, or misleading information. 1 understand that no construction may be undertaken on an OWTS until an OWTS Construction Permit is issued. Owner Signature (Required): Date: Applicant Signature: Date: FOR OFFICE USE ONLY Received by EN/HR Staff: Fee & Receipt #: Date: 6:\0WV S Marig 8, 2008 NEW RE 6S\Qlhce - Adnan funis\OWT:S Const for ts\tWTS G onSPruetjun permit appkcation.xis Updated --1077-078