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HomeMy WebLinkAboutPitkin.EH.273503402001 () (5)MEH/NR ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) CONSTRUCTION PERMIT APPLICATION 76 Service Center Rd - Aspen, CO.81611 Phone:970.920.5070 Fax:970.920.5374 Parcel 10* (available from the Pitkin County Assessor's Office 970-920-5160 or at www. itkinassessor.or 2735-034--02-001 Purpose of Permit: © NEW ❑ REPAIR DUE TO FAILURE ❑ REMODEL/ADDITION ❑ TANK ONLY ❑ FIELD ONLY Cost of System Repair or Remodel/Addition (approximate): New system Property Address: West Buttermilk Road c 5°l4 Lot Lot 1 Rlock- Filing: subdivision: Buttermilk Meadows PUD 'roperty Owner(s)•: Email Address: Linda Bedell % Mata Design Company hvner's Mailing Address: City, State, Zip: lome Phone: Business Phone: Contact information must be provided for the owner si_oninq this application Primary Contact Person/ plicant (if not owner): Company: Martin Ma a Mata Design Company ContacVApplicant Mailing Address: City, State, Zip: P.O.Box 189 Carbondale, CO 81623 Cell Phone: 970-274-6011 Business Phone: Fax Number: Email Address: matadesign@mac.com luilding Permit # (if applicable): of Size (in acres): 13.3 AC 47e of Building (square feet): J] Number of otential Bedrooms- 962 s.f. C�� � -- 2 ietached Accessory Unit? ©YES ❑ NO Size of Accessory Unit (square feet): Subject IS accessory Unit lumber of Potential Bedrooms In or Fixture List for the Accessory Unit: 2 brms eater Source: ❑ PRIVATE WELL ❑ SURFACE WATER ❑ SPRING COMMUNITY/PUBLIC WATER SYSTEM lame of CommunitylPublic Water System (if applicable): West Buttermilk Metro n ineerin Firm: Job Number: Phone Number: Fax Number. Ili h Lountr Engineering Job# 2151075 970-945-8676 tel 970-945-2555 fax lailin Address: City, State, Zip: 1517 Blake Avenue, Ste 101 Glenwood Springs, CO 81601 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 EWNR may revoke any permit I am issued If my application is found to contain any inaccurate, false, or misleading information. I understand that no construction may be undertaken on an OWTS until an OWTS Construction Permit Is issued. Date: teats . Ito OR OFFICE USE ONLY received by ENIHR Staff: Fee & Receipt A pate: iarct 200EVi _F(;SiUfY�. ,,dn�in',For!r�s`,Ce1�T5=ors =EtErS'JOA-5Conslu, aar.Updated: IW7l0