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LONGS PEAK WATER DISTRICT
. ,
9875 Vermillion Road • Longmont, CO 80501 • (303) 776-3847 office • (303) 776-0198 fax
November 24, 1999
Mr. James C. Docheff
1441 Weld County Road 28
Longmont, CO. 80504
RE: Confirmation of Water Service
Dear Mr. Docheff
This letter is in response to your request that the District provide you with confirmation that we do
currently and will continue to provide domestic water service to your residence(s) and dairy operation
located at the above address.
We do hereby confirm that the Longs Peak Water District does provide service -as described above-
and will continue to do so.
Should your operation increase in size and require additional service, we will provide that service in
accordance with District Bylaws, Policies and Regulations. Please be aware that should improvements
to District facilities be necessary to provide additional service, you will be responsible for those
improvements - again in accordance with District Bylaws, Policies and Regulations.
This is not a "commitment" for additional service, but rather a "confirmation" of existing and
continued service to your property.
If you have any questions or need additional information, please contact our office.
Best regards,
Barri-yke c j
Genera anager
EXHM
2000-0786 1
2n•A RBTo9LL 2oL-c.sl•O -Aa- .eM >lead s6uoi vea :oE 66-6e-AON
d'i••n""°0.., �' % .D COUNTY HEALTH DEPARTMENT SE#
ENVIRONMENTAL PROTECTION SERVICEb ORG PERMIT#
f�, 1517 16TH AVENUE COURT - REPAIR#
k GREELEY,COLORADO 80631 LOAN#
s.,4fa..,w PHONE: (970)353-0635 ISDS#
'FAX: (970)356-4966 . '
1 '.
STATEMENT OF EXISTING FOR SEPTIC SYSTEM '
(PLEASE FILL 'OUT IN SO
CK INK ONLYI
PARCEL# . 12 01 2-0 0000 87
PROPERTY OWNER DOOM E Fe DA- 1/2.7 PHONE No. ( 303) 691 - 45 '1
MAILING ADDRESS I Lf L4 I W C it 7_R t-01d6M O NT Co go 90 t-i-
City State Zip
DESCRIPTION OF BUILDING (ex. house, obile/ odular home,shop,office) M 0 a/LE Han
NoZT
SITE/LOCATION ADDRESS I NN I WtR 2B lithl 1-04/644 0 Atr tipn 5() `t
City State
LEGAL DESCRIPTION PT PT 5 I/t'I SECTION...2a_aI TOWNSHIP 3 N RANGE 68 V.
SUBDIVISION -IVA- LOT--N'4- BLOCK-HA- FILING-N4-
CENCUS TRACT - NA LOT SIZE/ACRES _
•
COMMERCIAL YES NO RESIDE
NUMBER OF PERSON�3 BASE PLUMBING
BEDROOMS BATHROOMS FULL 1 3/ 1/2
WATER SUPPLY UBLIC UTILITY NAME L0IV65 PR K M7P t I)1 ST&I C
PRIVATE YES O CISTERN WELL YES O ) WELL PERMIT# —NA
and has it OOO gallons capacity.
•
SYSTEM SIZE: Septic tank material is constructed of CaNG2 ETC feet YEAR INSTALLED 19 g3
FIELD: Trench 46-o square feet or Bedsquare
You are required t6 draw a diagram of the system on the reverse side of this form in black ink only and indicate
location,length,width,and distance from the dwelling.
The undersigned property owner hereby certifies that the above described septic system is in fact installed,as
described,and exists at this time on the parcel of ground identified by the above legal description and further sta
that the system js/is not in good working order and to the best of his/her knowledge js/is not failing to function
properly.
I further understand that any falsification or misrepresentation may result in revocation of any permit granted t
upon this information hereby submitted and ' egal action for jury provided by law.
NOV. i0 I999 6, AL7/N6 .45 gc 7
'
DATE OWNER ttr
. . DOGNEFF pzi/.E
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Subs ',ed and I orn o befor + 4J141/4"• • ��� day of t(Vb ��' 199 ,
by 4-i 4-t
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Witness my hand and official s I.; •
. , /commission expires: 0;
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DATE \ ' �`F OF.0O\Ptt N s TARY PUBLIC 4
STATEMENT OF EXISTING REVIEWED BY
ENVIRONMENTAL PROTECTION SPECIALIST
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