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Home My WebLink About20013532.tiff 1 • - �t` r'�' I IYI I DEPARTMENT OF PLANNING SERVICES RECORDED EXEMPTION COLORADO ADMINISTRATIVE REVIEW Applicant: Homeward Concrete Steps of Rochester, INC RE-3167 Planner: RA Legal Description: LOT B/RE-455, PT/S2/NW4,SEC10, -11 N, R66W, 6T" P.M., Weld County, CO Parcel ID#: 1471 10 000 062 Lot C Size: N/A Lot B Size: 74.3 +/- acres Lot A Size: 2.5 +/- acres Water Source: Well Sewer System: Septic Criteria Checklist Yes No X 1. Conforms with Chapter 22 of the Weld County Code and any adopted municipal plan. X 2. Compatible with the existing surrounding land uses. X 3. Consistent with the intent of the zone district. X 4. Consistent with efficient and orderly development. X 5. Complies with the Recorded Exemption Standards in Section 24-8-80 of the Weld County Code. X 6. Provides for adequate protection of the health, safety and welfare of the inhabitants of the neighborhood and the County. Approved with Conditions The Weld County Department of Planning Services has determined through an administrative review that the standards of Section 24-8-40.B.1 through 24-8-40.B.6 of the Weld County Code have been met. This Recorded Exemption is approved with the following conditions in accordance with information submitted in the application and the policies of Weld County. 1. A Weld County septic permit is required for any proposed home. The septic system shall be installed according to the Weld County Individual Sewage Disposal System (I.S.D.S.) regulations. 2. Prior to recording the plat: A. The plat shall be titled: Recorded Exemption No. 1471-10-2 RE-3167. B. In accordance with Chapter 8, Article II of the Weld County Code, Lot A shall be granted one residential/agricultural access. Direct access from a public road shall be limited to one access per legal parcel for residential use, no circle drives or additional accesses shall be granted.The road shall be graded and drained to provide all weather access. Accesses shall be placed in such a location as to have adequate sight distance in both directions, shall not be placed below the crest of a hill or where physical obstructions are present. C. Lot B shall use the existing residential access point as no additional accesses shall be granted. D. Lot B shall use the existing agricultural /oil and gas/ditch road access points necessary for agricultural operations as no additional accesses shall be granted. E. All approved accesses shall be clearly shown on the plat.The applicant shall contact the Weld County Department of Public Works to determine if a culvert is necessary at any approved road access point. If a drainage culvert is required, a 15-inch Corrugated Metal Pipe(CMP)is Weld County's minimum size. If the applicant chooses to place a larger culvert please contact the Weld County Department of Public Works to adequately size the culvert. F. Weld County Road 31 is designated on the Weld County Transportation Plan Map as a local gravel road, which requires 60 feet of right-of-way at full build out.There is presently 60 feet of right-of-way.A total of 30 feet from the centerline of Weld County Road 31 shall be delineated right-of-way on the plat. This road is maintained by Weld County. G. The Applicant has proposed a well as the source of adequate water for the Lot. Property owners are advised that the quantity of water available for usage may be limited to specific uses, i.e., "Domestic Use Only," etc. Because each situation is unique, the Department of Planning Services encourages property owners to contact the Office of the State Engineer, Division of Water Resources (1313 Sherman Street, Room 818. Denver, Colorado 80203. Phone 303-866-3581), to discuss each individual situation. H. If the proposed acreage for Lot A is surveyed at less than 2 /2 acres, it will not meet current Weld County Health Department policy. The Weld County Health Department encourages the applicant to keep the acreage for Lot A at a minimum of 2 '/z acres. In the event the applicant cannot or chooses not to maintain the minimum lot size, the following note shall be placed on the plat. "Future development may necessitate a largerLotA than what is displayed on the plat. In addition, a larger lot A would provide additional dilution and attenuation of sewage wastes which may beneficial to the environment." The applicant shall provide the Weld County Department of Planning Services with a certificate from the Weld County Treasurer showing no delinquent taxes exist for the original parcel. J. The following notes shall be placed on the plat: 1) All proposed or existing structures will or do meet the minimum setback and offset requirements for the zone district in which the property is located. Pursuant to the definition of setback in the Weld County Code, the required setback is measured from the future right-of-way line. No building or structure as defined and limited to those occupancies listed as Groups A, B, E, H, I, M and R in Table 3-A of the 1997 Uniform Building Code,shall be constructed within a 200-foot radius of any tank battery or within a 150-foot radius of any wellhead. Any construction within a 200-foot radius of any tank battery or 150-foot radius of any wellhead shall require a variance from the terms of the Section 23-6-10 of the Weld County Code. 2) Any future structures or uses on site must obtain the appropriate zoning and building permits. 3) Prior to the release of building permits, the applicant shall submit a recorded deed describing the Lot upon which the building permit is requested with the building permit applications. The legal description on such deed shall include the Lot designation and Exemption number. 4) Prior to the release of building permits, the applicant shall submit evidence to the Department of Planning Services that Lot A has an adequate water supply of sufficient quality, quantity and dependability. 5) Should noxious weeds exist on the property or become established as a result of the proposed development the applicant/landowner shall be responsible for controlling the noxious weeds, pursuant to Chapter 15, Articles I and II of the Weld County Code. 6) Prior to the release of building permits on Lot A, the Lot owner shall verify with the nearest Town/City or Sanitation District to determine the location of the nearest sewer line. In accordance with the Weld County Code, if a sewer line exists within 400 feet of the property and the sewer provider is willing to serve the proposed structure, a septic permit cannot be granted by the Weld County Department of Public Health and Environment. 7) Potential purchasers should be aware that Lot A may not be eligible for a domestic well permit which allows for outside irrigation and/or the watering of stock animals. The State Division of Water Resources issues all well permits 8) Potential purchasers should be aware that ground water may not meet all drinking water standards as defined by the Colorado Department of Public Health and Environment.The Weld County Department of Public Health and Environment strongly encourages well users to test their drinking water prior to consumption and periodically there after. 9) WELD COUNTY'S RIGHT TO FARM. Weld County is one of the most productive agricultural counties in the United States, ranking fifth in total market value of agricultural products sold. The rural areas of Weld County may be open and spacious, but they are intensively used for agriculture. Persons moving into a rural area must recognize and accept there are drawbacks, including conflicts with longstanding agricultural practices and a lower level of services than in town. Along with the drawbacks come the incentives which attract urban dwellers to relocate to rural area: open views, spaciousness, wildlife, lack of city noise and congestion, and the rural atmosphere and way of life. Without neighboring farms, those features which attract urban dwellers to rural Weld County would quickly be gone forever. Agricultural users of the land should not be expected to change their long-established agricultural practices to accommodate the intrusions of urban users into a rural area. Well run agricultural activities will generate off-site impacts, including noise from tractors and equipment; slow-moving farm vehicles on rural roads; dust from animal pens,field work,harvest,and gravel roads;odors from animal confinement,silage,and manure;smoke from ditch burning;flies and mosquitoes;and the use of pesticides and fertilizers in the fields, including the use of aerial spraying. Ditches and reservoirs cannot simply be moved out of the way of residential development without threatening the efficient delivery of irrigation to fields which is essential to farm production. Section 35-3.5-102, C. R. S., provides that an agricultural operation shall not be found to be a public or private nuisance if the agricultural operation alleged to be a nuisance employs methods or practices that are commonly or reasonably associated with agricultural production. Weld County covers a land area of over 4,000 square miles in size (twice the State of Delaware) with more than 3,700 miles of state and county roads outside of municipalities. The sheer magnitude of the area to be served stretches available resources. Law enforcement is based on responses to complaints more than on patrols of the county and the distances which must be traveled may delay all emergency responses, including law enforcement, ambulance, and fire. Fire protection is usually provided by volunteers who must leave their jobs and families to respond to emergencies. County gravel roads,no matter how often they are bladed, will not provide the same kind of surface expected from a paved road. Snow removal priorities mean that roads from subdivisions to arterials may not be cleared for several days after a major snowstorm. Snow removal for roads within subdivisions are of the lowest priority for public works or may be the private responsibility of the homeowners. Services in rural areas, in many cases, will not be equivalent to municipal services. Rural dwellers must, by necessity, be more self-sufficient that urban dwellers. Children are exposed to different hazards in the county than in an urban or suburban setting. Farm equipment and oil field equipment,ponds and irrigation ditches,electrical power for pumps and center pivot operations, high speed traffic, sand burs, puncture vines, territorial farm dogs, and livestock present real threats to children. Controlling children's activities is important, not only for their safety, but also for the protection of the farmer's livelihood. Parents are responsible for their children. 3. The applicant shall submit a Mylar plat to the Weld County Department of Planning Services to be recorded in the office of the Weld County Clerk and Recorder. The plat shall be prepared in accordance with the requirements of Section 24-8-70 of the Weld County Code. The plat shall be submitted within sixty(60)days from the date of approval by the Weld County Department of Planning Services. The applicant shall be responsible for paying the recording fee. 4. The Weld County Department of Planning Staff's approval of this Recorded Exemption Application is based on satisfying the Conditions of Approval. Should an applicant be unwilling or unable to meet any one of these conditions within 60 days of approval, then this case will be forwarded to the Weld County Board of County Commissioners with a staff recommendation for denial. By Date September 14, 2001 Robert Anderson ❖ Planner al IS 0e- 31 (11 Plat Checklist POC Planner Item Comments Check Check Proper size and material 24" x 36" or 18" x 24"/Minimum 3 millimeter polyester sheet I .--------w Lettering No stick-on lettering / Minimum 8 pt. lettering ti------a (.0„,.----Boundaries of Lots t_gn(a Scale Suitable Scale? '=201' .r 1"=100') L (J40 Accesses indicated Shared Access?If so, is easement Certificate included? Roads labeled, including R.O.W Building Envelope(s) ICI A Vicinity Map Suitable Scale? (Minimum 1"=2000') r/ North Arrow Z.--------- Legal Description L.•-• Notes from Planner! Development Standards Conditions of Approval orsk. S" o.Ke5 i EY'. ...i, La` Ir 1re45vrtc 5 0. a2oo°FFi cz zscS s Sets 8tty. ex \Owner's Certificate Notarial Certificate included? All owners must sign the plat, check the deed.Surveyor's Certificate and All surveyed plats L.....---/ Surveyor's Stamp Note: USR plats do not need to be surveyed Director of Planning Notarial Certificate included? (RE, SE, SPR,Final PUD if l.----------.. Certificate Staff Approved) Planning Commission (USR, COZ,Minor Sub. Final) 0 Jh Certificate Board Certificate (USR, COZ„Minor Sub Final) 0 IP (Final PUD,RE, SE&ZPMH if Board approved) y� Typical Road Cross Section (COZ, Final Minor Sub. and Final PUD) 1?7 Easements Na) A Please return the plat to the CAD Technician within 24 hours of receiving the plat. ACS *\0493J►-7loN- N.41. of (�� J -)..(- , 1 Planner on Call: (Initials) Qfl (At' Scotts() fof C/7/�"" hlot+tadic OF "Pau Planner Signature: '1� Date: III `I D� ck++t O1 Aotkar,za& shy"a tccour-TIT. 5017 Milt. 0 DEPARTMENT OF PLANNING SERVICES 1555 N. 17`h AVENUE GREELEY, COLORADO 80631 WI I D WEBSITE: www.co.weld.co.us C PHONE (970) 353-6100, EXT. 3540 FAX (970) 304-6498 COLORADO July 28, 2003 Louis Blanda 4600 CR 31 Ft Lupton CO 80621 Re: Conditions of Approval: RE-3167 Dear Applicant: On September 6, 2001, your application for a recorded exemption was administratively approved by the Weld County Department of Planning Services with specific Conditions of Approval. One of the required Conditions of Approval grants applicants sixty(60)days to submit a Mylar Plat. Should you choose not to complete the recorded exemption process and provide the required Mylar Plat, the Department of Planning Services will need to be notified in writing of your decision. If you do not formally withdraw your application and/or are unable to meet the Conditions of Approval, your case will be scheduled for a hearing before the Weld County Board of County Commissioners. Planning Staff will be recommending denial or your request at this hearing. If your application is denied by the Board of County Commissioners, the decision could affect future land development applications located on this parcel. Withdrawing applications will not generally affect future applications. Planning Services Staff is aware of the difficulty and associated delays in meeting the Conditions of Approval normally associated with land use cases, and is willing to work with you in completing your request. Please notify the Department of Planning Services, in writing,within 10 working days of your decision. Planning Services Staff can be contacted at the above address or phone number. Sincerely, The Department of Planning Services • . • DEPARTMENT OF PLANNING SERVICES Q 1555 N. 17th Avenue Greeley, CO 80631 Phone (970) 353-6100, Ext. 3540 Fax (970) 304-6498 Ci COLORADO August 1, 2001 Louis Blanda 4600 WCR 31 Ft. Lupton, CO 80621 Subject: RE-3167 A Recorded Exemption located on a parcel of land described as Lot B, RE-455, part of the S2 of the NW4 of Section 10, Ti N, R66W of the 6th P.M., Weld County, Colorado. Dear Mr. Blanda: Your recorded exemption application is being processed. If it is determined that the application meets the approval criteria of Chapter 24 of the Weld County Code, you will be notified that the recorded exemption is approved. If the staff determines that the application does not meet the approval criteria or if staff has concerns with the application, staff may elect to forward the application for review to the Board of County Commissioners. You will be notified and asked to appear before the Board of County Commissioners at a public hearing. You will be informed of the hearing date prior to the hearing. The Board of County Commissioners will then consider your application and make a final decision on the recorded exemption. If you have any questions concerning this matter, please call me. Sincerely, Robert Anderson Planner A FLOW SHEET r ;_APPLICATION Cp7ARAD0 APPLICANT: LOUIS BLANDA CASE #:RE- 3167 REQUEST: 2 LOT RECORDED EXEMPTION LEGAL: LOT B/RE-455, PT/S2/NW4, SEC 10, T1 N, R66W, 6T" PM, WELD COUNTY LOCATION: E/ADJ WCR 31 & '/2 MILE S WCR 12 PARCEL #: 1471 10 000 062 ACRES: 78.0+/- Date By Application Received JULY 27,2001 CG Application Completed AUGUST 1,2001 RA Referrals listed AUGUST 1,2001 RA Design Review Meeting(PUD) File assembled S I 01 W-1 Letter to applicant mailed s-tO t r I Referrals mailed 01 , Chaindexed S-1 -CI � Vicinity map prepared DPS Staff Field Check Air photo and maps prepared /200/ Administrative Review/Staff Decision: LhisC'eLu C-C o9 - O 6- O / 3"°`e r` Recorded on maps and filed /:—/A ' '�— Surrounding property owners notified Misc PC Hearing Date(if applicable), Action: PC Sign Posting Deadline: ❑ Posted BCC Hearing Date(if applicable),Action: BCC Sign Posting Deadline: ❑ Posted-S. Resolution Received/Filed Zone/USDA Class AG/OTHER Contact: Overlay Districts: Airport? NO Geo? NO Flood? NO Panel#0980C Road Impact Fee Area?: NO (SW Weld-#1_,#2_,#3_,Windsor_) MUD? NO 'GA? NO • . Information delivered to the Weld County Department of Planning Services The Department of Planning and Zoning suggests at the time of submission all incoming correspondence and Mylar be reviewed by the planner. In situations where this is not possible, please complete the following information to ensure that submitted material is given to the correct person. In absence of this information a delay in response time will likely occur. PLEASE PRINT LEGIBLY , Date Submitted: / i.2(XaV Listitem(s)submitted kfao'-, c Exempt:vA 4 /17/ — /p._7_ RE-3167 Person submitting information: �7� �'/ / Name: j� J a� x k AY Dl�( �� i L. ? J Telephone number(s): 30Z Rs'7-.),// , F3 0 8 7S .-Nza Fax number: d Q - 7 7 - /3 7 7 / Applicant: 3c3-8)S --/t/c// Name: Lana; s ` �L.C� vjc)q .a.1/2401. ;Ord ./L, Q Case Number: pr c.nriat A5 c '" Planner Working with: Inhcerr- A nA,-5on Has the recording fee for the Mylar been paid? vet If no, please pay$11/per page Submitted By: Mk,- L4 Date: 311 ti 1a7;.'J Received By: Date: M?\W PFILES\R0BIN\PLRECEIVING.wpd nEPARTMENT OF PLANNING SERVICES Weld County Admir�tive Offices, 1400 N. 17th Avenue, Gree Colorado 80631 Phone. 70) 353-6100, Ext. 3540 - Fax # (970) 3512 APPLICATION FOR RECORDED EXEMPTION O /6Pfl Application Fee .9�0 ^ Receipt Number 073 Yb Case Number 945-- Recording Fee Receipt Number Zoning District Application Checked By c(,t Planner Assigned to Case "Col-- TO BE COMPLETED BY APPLICANT: (Print or type only except for required signatures). I (we), the undersigned hereby request that the following described property be designated a recorded exemption by the Weld County Board of County Commissioners. y� PT S2NW4 10-1-66 LOT B REC EXEMPT ^0 � Legal Description: RE-445(1 D.56R2.26L)SITUS:4600 31 Total Acreage: Ace-",T..Zoning A G _CR 001 WELD 00000 Parcel Number: 1 L Z L i 0 0 0 IQ. 6 1 (12 digit number- found on Tax I.D. Information or obtained at the Assessor's Office). Has this property been divided from or had divided from it any other property since August 30, 1972? Yes No X Is this parcel of land under consideration the total contiguous land owned by the applicant? Yes X No Does the parcel of land under consideration lie in any of the following Overlay Districts? Flood Hazard: Yes_ No X ; Airport: Yes_ No X ; Geological Hazard: Yes_ No X FEE OWNERS OF PROPERTY HOMEWARD CONCRETE STEPS OF Name: _NOCCHESTER Home Phone#303 3572)gWork Phone# C/O LOUIS BLANDA Address: 4#600 We City/State/Zip Code Fort L upr04/L�o /SQF,.'t./ Applicant or Authorized Agent: i.0q r /VIII(In� Phone# 303- a--,,C 7 z / /L Addresst- CO tom,(- id : / City/State/Zip Code 0/ }(> -aa-- Name: Home Phone# Work Phone# Address: City/State/Zip Code Larger-Parcel S r Parcel Smaller Parcel -- �, Applicable oE for 3-lot - r P:?- /1 Pt Recordd e Exemption Water Source Welt w e_ c l Type of Sewer St p lr ++ c rd` c - Proposed Use S rid le FC '.I y "Rpsc int Acreage c2--.8 act re u.3e _ 7 7 - Z Existing Dwellings 4736 GCS) ijD� Yes or No no Existing Dwellings Address (if applicable): uu pv-O ' co Larger Parcel '1600 (AK-✓t 3 I P 062-I Smaller Parcel Smaller Parcel (applicable only for 3-lot Recorded Exemption) I hereby state that all statements, proposals, or plans submitted with this applicationh this application ice true a brre9 to to 2 the best of my knowledge. �i�/ Rev: 1-27-97 re:' Owp1� or Au — ize ge -- 5 _ • • # . . •, iii ii • lie I I 1 I. i CG,-J SEX c o,va_«o,,D I s.i. 1 1 �' E- 0 P LP Da I ro o V ' r. N -4- I t i ,- lI i I c i1 -y f y," I ' ! i ,f mot• .'% t 7 _______. X4 .7 1 1 7 R ' il 7----- - r-- S' + IL ` — r i '0 isat 6 ' IT • f N r c;, O 22 K D ` a w a A � I e i 11114 . y a, t t m . t_ r - r CD ± Ltd �_ it m • —4 a illAP- 4; � �, '„ r 4_ 1 ,--....,. _. _ _..._ 1... , -.i. , „ .. f a �� • REFERRAL LIST • NAME: Louis Blanda CASE NUMBER: RE-3167 REFERRALS SENT:August 1, 2001 REFERRALS TO BE RECEIVED BY: August 22, 2001 COUNTY TOWNS and CITIES _Attorney _Ault _X_Health Department Brighton _Extension Service _Broomfield _ Management Office _Emergency Dacono _Sheriffs Office Eaton X_Public Works _Erie _Housing Authority _Evans Airport Authority _Firestone Building Inspection Fort Lupton _Code Enforcement _Frederick STATE _Garden City _Division of Water Resources _Division _Geological Survey Greeley _ Department of Health Grover Department of Transportation _Hudson _Historical Society Johnstown _ Water Conservation Board Keenesburg _Oil and Gas Conservation Commission _Kersey Division of Wildlife: _LaSalle _Loveland Lochbuie _ _Greeley Longmont Division of Minerals/Geology _Mead FIRE DISTRICTS _Milliken _Ault F-1 New_ Raymer _Berthoud F-2 Northglenn Briggsdale F-24 _Nunn Brighton F-3 _Pierce Eaton F-4 Platteville _Fort Lupton F-5 _Severance Galeton F-6 _Thornton _Hudson F-7 _Windsor _Johnstown F-8 _La Salle F-9 _Mountain View F-10 COUNTIES _Milliken F-11 Adams Nunn F-12 _Boulder _Pawnee F-22 Larimer _Platteville F-13 _Platte Valley F-14 FEDERAL GOVERNMENT AGENCIES _Poudre Valley F-15 US_ Army Corps of Engineers Raymer F-2 _USDA-APHIS Veterinary Service Southeast Weld F-16 _ _ Federal Aviation Administration Windsor/Severance F-17 Federal Communication Commission _ _Wiggins F-18 _Union Colony F-20 SOIL CONSERVATION DISTRICTS Brighton OTHER _Fort Collins _School District RE- _Greeley _Ditch Company _Longmont _West Adams • • • fift RECEIVED AUG O 22 2001WEL D COUNTY C WORKS DEPT p Weld County Referral C. COLORADO August 1 , 2001 The Weld County Department of Planning Services has received the following item for review: Applicant Louis Blanda Case Number RE-3167 Please Reply By August 22, 2001 Planner Robert Anderson Project 2 Lot Recorded Exemption Legal Lot B, RE-455, part of the S2 of the NW4 of Section 10, Ti N, R66W of the 6th P.M., Weld County, Colorado. Location East of and adjacent to WCR 31 and 1/2 mile south of WCR 12. For a more precise location, see legal. Parcel Number 1471 10 000062 The application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Please reply by the above listed date so that we may give full consideration to your recommendation. Any response not received before or on this date may be deemed to be a positive response to the Department of Planning Services. If you have any further questions regarding the application, please call the Planner associated with the request. Li We have reviewed the request and find that it does/does not comply with our Comprehensive Plan ❑ We have reviewed the request and find no conflicts with our interests. See attached letter. Comments: • Signature pmat/d'''' // � 5r/3-' 300 AJ ..zj Agency f t(16,-4./341)ya) Date +Weld County Planning Dept. +1555 N. 17th Ave.Greeley,CO.80631 +(970)353-6100 ext.3540 +(970)304-6498 fax MEMORANDUM 4141 TO: Robert Anderson, Planner I DATE: August 13, 2001 FROM: Donald Carroll, Engineering Administrator Nl'-WI C. SUBJECT: RE-3167, Louis Blanda COLORADO The Weld County Public Works Department has reviewed this proposal. This project falls primarily under the Weld County Recorded Exemption Standards. Our comments and requirements are as follows: COMMENTS: WCR 31 is designated on the Transportation Plan Map as a local gravel road, which requires a 60-foot right- of-way at full build out. There is presently a 60-foot right-of-way. This road is maintained by Weld County. Pursuant to the definition of SETBACK in the Weld County Code, Chapter 23, Article III, Section 23-3-50, the required setback is measured from the future right-of-way line. WCR 12 is designated on the Transportation Plan Map as a local gravel road, which requires a 60-foot right- of-way at full build out. There is presently a 60-foot right-of-way. This road is maintained by Weld County. Pursuant to the definition of SETBACK in the Weld County Code, Chapter 23, Article III, Section 23-3-50, the required setback is measured from the future right-of-way line. REQUIREMENTS: The Weld County Public Works Department recommends approval of this application. The applicant shall indicate specifically on the plat the type of right-of-way/easement and indicate whether it is dedicated, private, or deeded to provide adequate access to the parcel. (Lot A) The applicant shall utilize the existing residential access to this parcel, and no additional accesses shall be granted. (Lot B) Utilize the existing agricultural, oil and gas, and ditch roads that are necessary for your agricultural operation. (Lot B) Ydeld County ptann,"10 Dept. • C E 144 ED pc: RE-3167 plan8RE.wpd • •Road File # RE: Other Case No. APPENDIX B WELD COUNTY ROAD ACCESS INFORMATION SHEET Weld County Public Works Department Date: r3/2 2-i100i 933 North I Ith Avenue,P.O. Box 758, Greeley, CO 80632 Phone: (970)356-4000, Ext. 3750 Fax: (970) 352-2868 I. Applicant Name \.. nu. S R I Lt.v\An.. Phone 303 857 ).19 Address Nti o0 a fe(1} C'u RD z i Ci• ty E /,T ron State.Q Zip 80C 2 I 2. Address or location of access ((/QO Ui eta CO Kb ( Section 10 Township I Range 66 tsiesr— Subdivision Block Lot Weld County Road # Side of Road Distance from nearest intersection 3. Is there an existing access to the property? Yes )( No #of accesses 1 4. Proposed Use: ❑ Permanent N Residential/Agricultural O Industrial ❑ Temporary O Subdivision O Commercial ❑ Other *************************************iii************************************************iii*************** 5. Site Sketch / Or Legend for Access Description: '} AG= Agricultural , 41t,, , RES = Residential le O&G= Oil&Gas D.R. = Ditch Road O Ltd --. 077 • 0GL- s 1`J ******************************************-mmtnettstt3SC1'ktvemns.n.of₹}} tnncoS.3?**S*m*?+nconcp*i*„ OFFICE USE ONLY: Road I ADT !,1.____ Date - - Accidents Date Road l; ADT ? 3v • Date L-/-J:} -5'o Accidents Date Drainage Requirement Culvert Size Length Special Conditions *********************************************************************************************************** ❑ Installation authorized ❑ Information Insufficient Reviewed By: Title: 7 ill i n FX t s'li ACA Q r r i.,__c ..•,, to J i -, i / r.ca (EX eVv.?t.o,r 1 i . CI) 0li -0, , a o U C I in 1 r �r , I o n � �. u / i , ° l /1 r _ ` / a f 1 n I ' - - _ i `•'; - - -- f i . . • toad File # RE: ' Other Case No. APPENDIX B WELD COUNTY ROAD ACCESS INFORMATION SHEET Weld County Public Works Department Date: 3/2 2. 1100 / 933 North l lth Avenue, P.O. Box 758, Greeley, CO 80632 Phone: (970 )356-4000, Ext. 3750 Fax: (970) 352-2868 1 . Applicant Name c. o t,� . 303 SS- 7 .219 6 pp S � U, LA, <��- Phone Address 6 i• fie( Cu RD 3 ( City F�- ,yinI-QA State Ca_ Zip $OCL,( 2. Address or location of access iii ‘ 00 p ( i Q t a C.O Kb 3 ( Section 10 Township I Range 6E uJ P S t- Subdivision Block Lot Weld County Road # Side of Road Distance from nearest intersection 3 . Is there an existing access to the property? Yes X No # of accesses I 4. Proposed Use: O Permanent N Residential/Agricultural O Industrial ❑ Temporary O Subdivision O Commercial ❑ Other * * * ** ** * ******* ***** *** * ***** * ********** *** ******** *** *** ** ********* ****** ** * ** * * ********** ****** ***** ** ** 5. Site Sketch i1- / Legend for Access Description: - AG = Agricultural a , RES = Residential - O&G = Oil & Gas A D.R. = Ditch Road 0 Z'-1 0 4 077 rQ'Vw: kc z) SiJ **** ********** * ************ ********** ****** * **# #*tittim trnmst '#. mien suing **. *_ ,****_**** *** * *. OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT ' Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions ***** ** * ** **** * *** *** ** **** * ***** ** ** ****** ******* ** * * ** ***** * ****** *** *** * ** * * ** * * ** *************** * *** *** O Installation authorized O Information Insufficient Reviewed By: Title: 7 • • Memorandum TO: Robert Anderson,W.C. Planning I ::tx::' 200C• , EH Services COLORADO CASE: RE-3167 APPLICANT: Blanda, Louis Environmental Health Services has reviewed this proposal; the following conditions are recommended to be part of any approval: 1. A Weld County Septic Permit is required for the proposed home septic system and shall be installed according to the Weld County Individual Sewage Disposal Regulations. 2. Prior to the release of building permits on lot A, the lot owners shall verify with the nearest Town/City or Sanitation District to determine the location of the nearest sewer line. In accordance with the Weld County Code, if a sewer line exists within 400 feet of the property and the sewer provider is willing to serve the proposed structure, a septic permit cannot be granted by the Weld County Department of Public Health and Environment. Additionally, please note the following: 1) Our Department recommends the applicant to set aside an area for a septic system replacement envelope. 2) This application is proposing a well(s) as its source of water. The applicant should be made aware that while they may be able to obtain a well permit from the Office of the State Engineer, Division of Water Resources, the quantity of water available for usage may be limited to specific uses, i.e. domestic use only, etc. Also, the applicant should be made aware that groundwater may not meet all drinking water standards as defined by the Colorado Department of Public Health and Environment. We strongly encourage the applicant to test their drinking water prior to consumption and periodically test it over time. 3) If the proposed acreage for lot A is surveyed at less than 2 'h acres, it will not meet current Weld County Health Department policy. We would encourage the applicant to keep the acreage for lot A at a minimum of 2 Y2 acres. However, in • • the event the applicant cannot or chooses not to keep minimum lot size, please place the following note onto the plat. Future development may necessitate a larger lot A than what is displayed on the plat. In addition, a larger lot A would provide additional dilution and attenuation of sewage wastes which may beneficial to the environment. 4) Topographic or physical features of the proposed lot, such as ravines, ditches, streams, etc. may limit the area available for a new or replacement septic system. Prior to recording the plat the Division recommends that the applicant review the County Code pertaining to Septic Systems to assure that any installed septic system will comply with all setback requirements found in the Code. In the event the proposed lot is not of sufficient size to allow the installation of a septic system the lot may be need to be enlarged. M:\ENVIRONMENTAL HEALTH SERVICES\PLANNING\RE-3167.wpd BANK OF THE WEST BRIGHTON OFFICE 1795 EAST BRIDGE STREETcn BRIGHTON,CO80(501.197 0 a . rl a' cn R. V) 0 P co n 0 co cn 5 a C ft sr an w ACCOUNT'No. i 1-305624-6 x.no 160780976 ant E y'9 HOMEWARD CONCRETE STEP OF REICH. INC. . 4/25/98 'O _._.... nus.NEss.conpon,NA..E E 4600 OCR 3 i — 1 , 807. 25 amaFT E LUPTON CC 8062t S2₹400-000000-0 TA FHAi _!OUTS BLANDA PRES. _. rip DO-000000—O Si army"NAME Al EO n,cNeii vaME alarm PEO. 557-2196 9,ONEn NAME — pnCNE I N/A---. 00 Eno. E owN 6 L 40 N/A OOOE € ° 4 b w Oct� N NJ 0 O 0 M CT NJ BANK OF TIM wi`fi`,- .. BRIGHTON OF rh'I c, 1795EASTBRINW rd-H r 1 BRIGHTON,CO WWI W_4) rip C CD CD iiil c4 42 CD a C . 7 n G OJ= iv.,.ft crafty apply op a c neckirly ft IV W 17 ictigAU A7°fYIlWr�OR�t VaLUNTARY PASSOCZATZON ACCOUNT PtP .�..P... .etas. .o a k, . I.ft0refft..a am Is ..aftf If.ant :,e aPP x.,.00.state ana reaerat.a.„.ana rao...4ton.. hot...a.at.00ta>ot to ti tettery n rinformmaattion providatl onrI nis form is [nat.. cotract'and'corn plate SUBJECT TO RACIF UP W ITNNOLO • INS ETION340B a*1LE'I'I i[PROVIC3IOOF8 OF .. X INTERNAL REVENUE CD! III q- .+ b w 0 N N 0 0 0 M 0\ N CERTIFICATE OF CONVEYANCES WELD COUNTY STATE OF COLORADO DEPARTMENT OF PLANNING SERVICES COUNTY OF WELD Land Title Order No.: Homeward .Update The Land Title Guarantee Company TITLE INSURANCE or ABSTRACT COMPANY hereby certifies that it has made a careful search of its records, and finds the following conveyances affecting the real estate described herein since August 30, 1972, and the most recent deed recorded prior to August 30, 1972. LEGAL DESCRIPTION: Lot B of Recorded Exemption No. 1471-10-2-RE445, recorded April 16, 1980 in Book 900 as Reception No. 1822314, being a portion of the S %: of the NW '/4 of Section 10, Township 1 North, Range 66 West of the 6th P.M. CONVEYANCES (if none appear, so state): Reception No. 18450931 , Book 923 Reception No. 1822314 , Book 900 (informational purposes only) Reception No. 1469410 k. , Book 543 Reception No. , Book This Certificate is made for the use and benefit of the Department of Planning Services of Weld County, Colorado. This Certificate is not to be construed as an Abstract of Title, nor an opinion of Title,nor a guarantee Title, and the liability of Land Title Guarantee COMPANY, is hereby limited to the fee paid for this Certificate. It Witness Whereof, Land Title Guarantee COMPANY,has caused this certificate to be signed by its proper officer this 24th Day of July, 2001 at 5:00 o'clock P.M. LAND TITLE GUARANTEE COMPANY Weld County Planning Dept. J:> X 2'a 01 By: a au Wend Bell RECEIVED Title Examiner s7 L32/02 O.2 13 92 Recorded at —� o, T� DEC a 3 }� 1845093 c'i Rec. No.____ _9 S State of Col redo. Weld County Clerk & Recorder J` 1 WARRANTY DEED 1 KNOW ALL MEN BY THESE PRESENTS, That we DORSEY L. o r, GLENN and NELLIE A. GLENN whose address is 4502 Weld County o Road #31, Ft. Lupton, County of Weld and State of Colorado for 0 the consideration of Ten Dollars and other valuable consideration 0 in hand paid, hereby sell and convey to HOMEWARD CONCRETE STEPS ri OF ROCHESTER, INC. , whose address is 15390 Route 31, Albion, ri c> o New York, 14411, the following real property in the County of Weld cd, a and State of Colorado, to wit: ≤: w r" Lot B of Recorded Exemption No. 147130-2-RE445,recorded N 4l April 16, 1980 in Book 900 as Reception No. 1822314, being N a portion of the 5' of the NW's of Sectiyn 10, Township 1 `3 North, Range 66 West of the 6th P_.-14.{_�t,oge_ther with. 4 shares of The Burlington Ditch/88W sttd s of the capital stock"of-The-Wellington-Witch..."of-The-Wellington-Witch-zros& Reservoir Company and 4 shares of the capital stock of The Brighton Lateral Ditch Co. RESERVING, HOWEVER, unto the grantors one-half of all royalties now being paid under oil and gas lease wherein 0 b Energy Minerals Corporation is the lessee, recorded October 14 , 1970 in Book 634 as Reception No. 1556061, Weld County Records and in the event that the said oil and gas lease should expire before the end of the term �Q of this reservation as hereinafter set forth, one-half e-b of all oil , gas and minerals associated therewith for a 4 term which will expire at the occurrance of the first of the following events: (1) twenty years from date of this deed; (2) at the death of the survivor of the grantor; (3) upon conveyance of Lot A of Recorded Exemption No. 1471-10-2-RE445 recorded in Book 900 as Reception No. 1822314 (which is contiguous to the lands conveyed herein) by the grantors and by which they retain no interest in said_._Lot,A. _ with all its appurtenances and warrant the title to the same, subject to conditions of the United States Patent recorded October 15, 1909 in Book 132 at Page 255, Weld County Records; easement and right of way described in and granted in Farmer ' s Reservoir and Irrigation Company, recorded January 27 , 1911 in Book 323 at Page 198 , Weld County Records; oil and gas lease recorded in Book 634 as Reception No. 1556061, Weld County Records; and the 1980 taxes payable in 1981. Signed this ,73-fn1da' of Cid. , 1980 . I State Documentary Fee DEC 23198D 198D SE L G,.ENN Dose ore s (y. CO � rATE'- cQLORADO) NELLIE A. GLENN OUNT • HELD ) ss . ,t' ; ',51%MfW fotegoing instrument was acknowledged before me this ).. . f y af:: December, 1980 by DORSEY L. GLENN and NELLIE A. GLENN. e , f ' $,) my and and official seal. s� `� �ornssion expires: o��4 /s;/9f • Notary ublic TOTAL. P.02 • • . L x f I ,z. 17 Inc I I 4 1 •Pr• ',lib,1 y.tiJl•1 'n. Ytw.��i«.. . t. RECORDED EXEMPTION NQ 1471-I0-2-RE•445 M IA NI ' { .:1 wasCoon17 Rood It ———— ---- , : P# A p J I I 1 ,r lc eif I 1 1 s '+*--A+d. III'.. e Ilia V. • f, tr to,, s ass" ( Ii .. apapp� M w on aN. it 2 v x .. i a, t 7•.•0• Iowa w or I.R SI MISMON IT ..- /nal ` LOIIOM �1.1 - tie M•wbo's—sssaa ilia "• / IM . F l • t • Demotessa•I vI. LOT 'A' Contains 5.456 Acres ' SCALE: I " = 500' LOT 'B' Contains 76.809 Acres TOTAL 82.245 Acres ;::<fi N i • e ''r .1 OWNERS: DOftSEY L. 6 NELLIE A.GLEAN L 4502 WELD COUNTY ROAD >N ' d N FORT LUPTON, COI.ARA00 TOON 10 i . I INN. ALPHA ENOINGEW S °t nay 617 51A STREET .. • ,4 t FORT LUPTON, 004M 000 ' .`el 80621 '' " b FEURtUN1Y 6, 1980 Location Mop s•nI I N s ki p, wr 41 „ .rte-.,--. Tan,,;, . ti' Itl_a a • 3( x .rat Jul 1 965 0 ° .t•' r. n • ” !( Y'1 e} Raaedad ._.. _a—___ ea ILE� JataA It. ti:1 ,5r1M It -TV?';'.• gore 54 3 Racepden Na 1,11;4910 - --•tad wow, ',cos.,. i I ^� Tz r III f u1 ' its �j{ • :11A .a4, 'id&A.±....,-,• k' Y 111ill($ PPcb1 Made lb.. First als) d June l. .O4 +i"`5 F..., y year of our Lord one thousand nine hundred and •ixty-flwe between ,l' ' (e , CI w9' ` DAVID A. ROGERS FI LPara,A l� }r 4� of me Cwvtr of Weld ad State d Cobrde,d tbea. a ;. 4 .. 111., CFA- re '7 Rem pmt and. DORSET L. GLENN and NELLIE A. GLENN ii To N("'r .y rt ef'r'b;�r IA • N1i(vaA;'. 1 r d the Conk d Wald and Stain d Calme4 d the y,l.t i h F 1 C i wend pan: WITNEISETH: That the said party d the first pan.foe and in consideration of the aw of " v + t^ Ten Dollars and other good en( valuable considerations-- I e i31 it ti ( .. .pi to the laid pang of the first part in hand paid by the mid parties of the second part the renipt whereof Is n}L l hereby confessed and convey lodged ha a punted bargained told and conveyed. and by these n do ea yy.p 6a t•ji's NI:` j '� sent,bargain sell. convey andcoal,-[ • the said parties of the second part, to past not in tenancy in commas 1, W y 4 but in joint tenancy.them I m. their assigns and the heirs and assigns of such survivor forever.all the lab- � yet ry in a lowing described lot r Ise. I of lend situate.lying and being in the soy `d's,'Ip�l, es ,+ County a1 Weld and State of Colorado, to-wit: it t,/ n S'.� The South Half of this Nnrrhwegt Quarter ,w, A' 11j (SSNWt) of Section Ten (10), ' ` Township ;"elr'' ,,. 5 •• � ': * }` jfri' 7S One (1) North, of Range 66 West of the }g -111."7 T „Ili 4. + r t (1 6th P. M., Weld County, Colorado, together ia i )•J 'r' with four (4) shares of the capital stock €r (t ytl. h ?I. *. ‘ of the Burlington Ditch, Reservoir and . )i7 a 7ff{ vA7p„ .• Land Company, four (4) shares of the capital g'Lif t,, a4�fill' stock of the Wellington R it Company btt,A and four (4) shares of the capital stock of I/ h *+ it the Brighton Lateral Ditch Company. -, ;y. { TOGETHER ,soh all ani singular the heredtlame,us and a pantos'''.i Oneonta belonging, or In any wise I '. appertaining, 1 a e rl the and r r n' r ad , n rater r a, In rent on er s and profits thereof; and •e, all the e.eu r r. right. tlte. intern? claim and Armand wl aisorver oft the said part y of the carat part,either in O. 1 law or e.t,... p t. in aid to the above bargained premises the bernbt.m,ash and appurtenances •'c ' '; TO HAVE AND TO HOLD the sad premises above bargained and described with appurtenances, unto the , t mid pan,.of the second part ter sea.viroe of then,, their noonand the h and assigns of such survivor fur. ,.r AL-.4. ever. A,d the mid party of the firm part tor li i a sal f,his lee. en.woes and administrators, do Oa •�i. nbj covenant, grant, 'aid bargain and agree to and with the parties of the acond part, the 'ma'amof them, their 5(w u .y` q'f aS •(gnat and the hen and assigns of such survivor that at the rime of the nncain's a d delivering of these presents,a i(, a . { :ttT he i• well d of the premise. abnve cons eyed as of good. sure. perfect. absolute and indefeasible estate . (�.: Y'TTTT, _ of in her in I t 1 ti ply and has g•.,d relit lull pawn and lawful authority to gran bargain. 4A Yv,,fA 6. d of - sell and convey the a t manlier and form of rasa t and that the tame ate free and sitar from all format and other grants, bargains sale,. bens tans asseasmenu agent incumbrances of whatever kind ot nature aoen �. }�A5. Except taxes for the year 1965, which the grantees assume and (:+•^;:y. ? egret to pay. < zn� _ ,.i.;...ft• o 1 1,� ` resent(nit'et(� rril tin.-.,,�. and the above I aeganed pennon in the gain a d P rielde miVI(AQ Ra t of n ilF: a•cyan the i ke . v n r of them, their a,sans and the hens ands ON s1. amen dd611all sat---e-—'."'—persons M.,• `t lawfully claiming or to dim the whole or any pat thereof. the said out y of the lint pan shall and will .'r. • WARRANT AND FOREVER DEFEND. .o.--,— .1 IN WITNESS WHF:Rfu.l, itie sail party of tLr lint part ha a hereunto set hi• head and seal ibe day and year fuel above airmen S.gned, Sealed and Del I in the Presence of 1,,CT(A-e rt. ` (.,<�Oc7}-_4.L_(gaAL) `I David A. Rogers J h ,i - --- _ _...__._____..(SEAL) •t • '... S es .. _...._ ._- _. _______. .. ORAL) • q, . STATEeet'CQTSIRADU,1,,. The lore rc_w ) forerun(mt!rumtnt was a k-cnlydYd ieel••re m<Phu a e t day d „ ln,my of lV(L�,, y -rite z.• fY. D 65 by David A. Rogers. - _. `f' r ' I ` 0.elt..m My Had rd Wltmal Sri _----- .• O yy My Cordaro Erptng .//,µ L L-l e 7 Pi/6l or .. a pV 1 ____ ) .1 *ht..:r . _._ _i, , . . 1.y '/_CC C L c. ti _err --, " WARRANTY 7[[D I„ Jbunt rename • - - 4a• • -.--,an li,As ., u, k y M .. • 11mbIR . - — pg... • • • - 7- we - i 3e �L s-‘e,79 sy --eiE�� s-t o e L 7,41119 A s e Iq 7-41(e41,- err t6a(y— /J✓/d' o ale 71/4/i/AC C;' t1/417--s --- 0'Y- -Se fo g , 4' 6 -7724tie s- y y q ye s 1110 )/e .s // -r w A 0/ ,e 4-- l S u e)/ D,2 //v nt, 4?6- 7 )/(e / 3 x • • • COLORADO DIVISION OF WATER RESOURCES r • PE Fe irri aL.:cx INK818 Centennial Bldg„ 1313 Sherman St. COPS OF ACCEPTED Stare wF Ni MAILED Denver, Colorado 80203 ON REUuEST STATE OF COLORADO f AFFIDAVIT COUN1 V 0 -- STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD LATE REGISTRATION '2 PERMIT NUMBER 121-1 132 LOCATION OF WELL fHE AFFIANT(S) Dorsey L. Glenn whose mailing — co„„„ Weld -_ address is 4502 Weld County_Roitd 21 _ SW City art 1 up1on.„CO.130621_ T 1 __. . N.., --- ..P- A--.--- N 66 W 6th being duly sworn upon oath, deposes and P says diet lie (they) is (arc) the owned s) of the well dcacnhed hereon, the well located os described above, of distances of 1765 feet from the North section line and 875 feet Iron WPct section line; water from this well was first applied to u beneficial use for the purpose(s) described herein on the r..,. t r n day of June , 19.3a; the maximum sustained pumping rate of the well is 498 yullons per minute, the pump rate claimed hereby is - 498 gallons per minute; the total depth of the well is 17 fe et, the overage annual umu of water to be diverted is acre-feet; for which claim is hereby made for Irrigation purpose(s); the legal description of the land on which the water from this well is used of wh 60 acres are irrigated and which is illustrated on the mop on the reverse side of this form; thus this well was completed compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with low; (they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowled (COMPLETE REVERSE SIDE OF THIS FORM) Signeture(s) Subscribed and sworn FOR OFFICE USE ONLY to before me on this day of 19 W8681 My Commission expires: - ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO Aeallatf4DIFOIVIllgINOLLowiNG CONDITIONS: Sec BY Ti,E. OFFICE OF THE STATE ENGINEER ACC^?]a!G TO THE _ .. /":" GRANTED UND D. GI. 1 ]•j 113. E t CASE �d ) WATER DIVISION PURSUANT TO SECTION �/ /s 37-92-304 (8) , CRS (s✓l G 1973. DATEf era, $ 19R7 i�AAAf�t�;_ . .... •. / / - c / / r < • WELD COUNTY'`HEALTH DEPARTMENT, 'r*'4 r "Sr ,t `�?'; 1516 Hospital Road , , Permit, No.g(,2 ' - Greeley, Colorado PH. 353-0540 Application for . pp ✓/ perm�t to install, construct, an Individual )$ewatgJe Dlpposva .System. Owner , Th - ,f/ ' i';{ .. , /rl" Address �71� r� r;'1/iGn�-��r ?Phone ;:'-T7--)l Dir lections tto ite: Hwy f".5.--, Rd. /� Wall:, E mi, S. mi', W. myi ! Itl ;'I'Q h�c I `=� 'C/1,(1 ., r ni 4'1`,lt 6. ._Jq-f)5, !' 1 r, .4 +''?flat ifiSS w+ txn b v x A LegaltDescription: ?tune.? r, fR. -i Sec. /j) ,T / '/N, R4'W,,,,Sub. `, f hd .Lot,��Blk. f _r— rUNd/T�TP rika"r'=elf,{a�5.. ',eiVi�l�+ t�T�.rb�{N9k • General Information . ' =De 't t,Use: On'1 J1 ;;:; g};L, No. Bedrooms >'t S No. Persons 3 Perc rateavof 3) r$��.�.t - -5 No. Baths / Basement Plumbingicr�Nrt,a, .-(,),), Soil, Type" g g " `�''4: r "pae/R e .i Size of Lot "j7 //PH (( a 1 ° H20"Table Depth ' gar M1.'x4;''. H2O supply (If well ,give depths ,,,at frt. ,“i4 tkili to e Vp . `Lot'Grade )sitj ,'"r B YaQ., a4 New Home c,.-Mobile Home - Modular ' Add'n / Engineer Desigm"1 7"E,r4Yesee6Z4 t Type of sewage dfsposal requestedI:\ I If YES-reason ti ,,, &k'4, ' Septic tank --"-Privy Other Comments'+: ''r� ': \' , '''' ' '''';''''':<'',4:70,t-i'E'4; ' ,:,-1 This is to certify , that the system i s ,N0T,within 400 ft. of a ;public,sewer . 9 F j'; ., .) kV-4 Installation ins'tructions:' (MinimumCRequirements) I / P!• Septic Tank I Gals. Absorpti\pn Trenches' r- Sq bt Special Instructions 1 Seepage Bed tQ"�7� ` `( '�' ` `Sq 'r;'Ft This system will bec onstructed and- i stalled in accordance with' thbove specifications and regulations regarding'kindividual^Sewage disposal system's in Weld 5County, Colorado ' -� This permit shall expire at the same ime' as the wilding permit,;or,r�if nolbuilding: penal is issued, the permit shall expire 12 days after its issuance ifrconstruction hasc,ot�t�t been commenced. I s j114-,'' P ilie ;` ' `';i 47 Date: i!. ;x , - / Owner-:_t;AeC;ra t m .^ )� , 4 Appl cant , ,., x, hf ` . The plans and specifications as shown are approved pendli ayment ofxtpermit fee . ^ Date: 1 D $ k 4 t bai A tee{ �3i� ti �2,2 it + r� _ rs Sanitarianr -- 7,9,j� '0a .9, The above system inspect9d d found to comply with planes de�s`c�rsi ipv " k� x rg`� ; ✓✓ Date: k + :3 �f Systems Contractor; ti Sanitarian , 4 Engineer Review: '\ ' ^r•.i . • .. e� t (Date) -.(Signature)r a .z , ' 1 / J U C/ Permit Fee: $ 1 ' /,,, \ ' I y,( 0, F'� f�-'?,t , wt .. qh- .4 fyrt tax, Received by: _, it //,_(2-144. )T n , ,.. ".1C Date:_ a _jwa i 19-79-122; Hello