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NORTH WELD COUNTY WATER DISTRICT r SO,::5 3324/11'O1 Aav Er w'EROE.OO80649 PF ,E(0:0o ,cau f AE 970190 099/ E MAi: ry rrr. ,Quwe Erg
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• 2011-0373
WATER SUPPLY INFORMATION SUMMARY
Section 30.28.133,ld1, C.R.S. requires that the applicant submit to the County,'Adequate evidence that a water supply that
is sufficient in terms of quantity, quality and dependability will be available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
2. LAND USE ACTION
3. NAME OF EXISTING PARCEL AS RECORDED
SUBDIVISION ;v )-f" FILING BLOCK LOT
4. TOTAL ACREAGE i 1 ! r 5. NUMBER OF LOTS PROPOSED `1' PLAT MAP ENCLOSED 0 YES
6. PARCEL HISTORY - Please attach copies of deeds, plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1, 1972? C YES 0 NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? 0 YES G NO
If yes. describe the previous action F
J
7. LOCATION OF PARCEL • Include a map deinletinp the project area and tie to a section corner.
1/4 OF ; F_ 1/4 SECTION J , TOWNSHIP C Di( N C S RANGE ' , ❑ E xr•W
PRINCIPAL MERIDIAN: ❑ 6TH G k.M. 0 UTE 0 COSTILLA
8. PLAT • Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat C Yes ❑ No If not, scaled hand drawn sketch ❑ Yes ❑ No
9. ESTIMATED WATER REQUIREMENTS Gallons
par
t)a or Aen Fpt per Ysar 10. WATER SUPPLY SOURCE
❑ EXISTING 0 DEVELOPED 0 NEW WELLS
WELLS SPRING FROMM A .10=ONE)
HOUSEHOLD USE # of units GPO AF WELL PERMIT NUMBERS 3 ALLOW
0 UPPER ARAHHOE
IRltn DARS01 ❑MIER AA1WANOE
COMMERCIAL USE # of S.F. GPO AF uneO oAwsen MANE FOX NUS
_7 INNER
IRRIGATION# of acres GPO AF
STOCK WATERING # of head GPD AF 0 MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER GPO AF ❑ COMPANY
TOTAL ❑ DISTRICT
GPD _ AF NAME
-
LETTER OF COMMITMENT FOR
SERVICE ❑ YES ❑ NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES 0 NO IF YES, PLEASE FORWARD WITH THIS FORM. (That may bi ntauced views our nviAw s compioudJ
12. TYPE OF SEWAGE DISPOSAL SYSTEM
y SEPTIC TANKI:EACH FIELD ❑ CENTRAL SYSTEM • DISTRICT NAME
LAGOON C VAULT • LOCATION SEWAGE HAULED TO
ENGINEERED SYSTEM ,Att.ctt o copy of mpmswmq duignl G OTHER
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