HomeMy WebLinkAbout20011679.tiff Tap No. c4S0
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LITTLE THOMPSON WATER DISTRICT
Domestic Water Agreement
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This Agree��ry nt made this O7g i da tof \,C1 y^1�)y�- ,19 by and between
.1 )Y C l- fl1 ) C ��Q E. b-CI \Y1�.YC.kl i Land Owner, Hereinafter referred to as User,and
LITTLE THOMPSON WATER DISTRICT, a statutory water district, herinafter referred to as the District, i upon the
following terms and conditions, for the property and water tap shown below. 1,
Legal Owner of Property: I "J l I ‘2_.‘. \- Y \i\ IC
�QI Q PP 1 n Y lc,r
Street Address of Property: I 'rn(o.3 �1u )V `r,"v
^
Town and Zip Code: 14S I T t k �VLc vm SOS LTWD Tap No:
„rsarri' Service:
Residential Single Family ulti-family; Commercial; or Other(describe)
WHEREAS the District is the owner of facilities for the purpose of furnishing Domestic Water to users within said District:and
WHEREAS the user is desirous of obtaining domestic water for his property,
NOW THEREFORE, the parties hereto agree to the following:
I. This agreement shall be the binding contract between the User and the District.
2. User hereby agrees to pay to the District such sum as may be prescribed from time to time by the Board of Directors as the
water rate or charge for such water service. Payments shall start when the District installs the tap and water is available for
delivery. A minimum payment, as prescribed from time to time by the Board of Directors of the District, shall be due and
payable regardless of water use.
3. Until paid,all rates,tolls,or charges shall constitute a perpetual lien on and against the property served,and any such lien
may be foreclosed in the same manner as provided by the laws of the State of Colorado for the foreclosure of merchanic's lien.
The District shall shut off or discontinue service for account delinquencies or other violations of the District's Rules and
Regulations.
4. No water service may be obtained except upon property included within the boundaries of the District. User agrees to
include the property served within the District,if this has not been previously accomplished.User further agrees that he will
not permit other persons to use water furnished to him under this agreement.
5. District agrees to furnish water to User PROVIDED,that the District shall not be liable for loss to User for failure to deliver
water because of war, riot, insurrection, breaks in the water system or Acts of God.The District shall endeavor to repair all
breaks promptly on District lines.
6. User agrees to abide by such other rules and regulations of the District regarding the use of water as may be established from
time to time by the Board of Directors.
7. The user's name and billing address for all statements and notices is:
i� 'Q a- w LOC
f 4,C\ :\\VN,er. S 2
1v _ � _
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Phone: � o
IN WITNESS WHEREOF the parties have subscribed their names the day and year first above written.
r LITTLE OMPSON .ATER DtS LI i \\ 2001-1679
BY: •
(Signature of Land Owner)
EXHIBR
LTWD Form 120 :, ehOrv. \-- I _1:2,(1.) ._
(Rev. April, 1986)
LITTLE THOMPSON WATER DISTRICT CC
WATER TAP APPLICATION TAP NO: J O
TO:Board of Directors,Little Thompson Water District
Application is hereby made for domestic water' service to the following
described property
Legal Owner of Property: RI e \ `\ '^c1\Ent' (I e 6e Y "1 n c (C\
Street Address of Property: I a• ( )3 1`'W (D J
Town and Zip Code: 01-\ 1 l\V)e I 35
3 Lot No:_
Subdivision:L Y C 77-, ((-)0,81 .��� � � Block No: Jrl
Section: to Township: t-} North, Range: l 07 West of the 6th P.M. County: t Up i cV
Applicant understands that if this application is not accepted by the District,or in the event the applicant decides to withdraw
this application for water service prior to installation,the tap fee will be refunded to applicant,with the exception of any actual
expenses which may be incurred by the District in processing this application.
Meter Size Tap Fee
5/8'
3/4"
1"
�. L5"
2"
Notes:
Tap sizes larger than 2"will
/will be charged a fee as set by the Board of Directors.
TAP FEE —) .�.. ) IMPACT FEE 1 0 S O SPRINKLER TAP FEE
Applicant understands that property must be included in the District boundaries for service and agrees to furnish a complete
written legal description of the property served prior to tap installation,if so requested.
-If application for service is accepted,applicant understands that the water service is subject to the rules and regulations of
the District,as currently established,or as may be modified in the future by the Board of Directors. A copy of the rules and
regulations for the District is available for the applicant,if desired.
Applicant certifies that final lot grade will be established prior to installation. The District will not be liable for the
expense of a meter relocation if required after installation due to a chang in lot grade.
'
ignature of Legal Owners) (Signature of Applicant
jiqiti1�
(Street Address)
,..., FOR DISTRICT OFFICE USE ONLY 'Ito_ __Sown erg Zip Code)
:ap Number: r5 j h / Area: 6'7 -
Tap Fee Rec'd: '7-3O O (Telephone Number)
Land Included in District: District hereby acknowledges receipt of
Meter Book: $ '6 50 • XXJJ
Map Number: Node Number:_
Date Tap Installed: � ,
Job Order#: 15 (p `h District Representativ > Date
WELD COUNTY DErARTMENT OF PUBLIC HEALTH AIN'J ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX(970) 304-6411
Permit#: SP-9900415 Sec/Twn/Rng: 12 04 67 Status: ISSUED
Owner: BERNHARDT BRETT& MICHELLE Applied: 08/20/1999
Applicant: BERNHARDT BRETT&MICHELLE Issued: 11/24/1999
Permit Type: RNEW Commercial,R=Residential+NEW,REPair,VauLT Finaled:
Parcel#: ??
Location: 11263 HWY 60 MILLIKEN 12-4-67
Legal Description: 21922 N2NW4 12 4 67 (3D 4R) SITUS: 11269
60 HWY WELD 0
Installer:
Description: HOUSE
Commercial: N Residential:Y Acres: 754791
#of Persons: 4 Basement Plumbing: Y
#of Bedrooms: 3 Bathrooms - Full: 3 3/4: 0 1/2: 1
Water Public: Y Water Source: LITTLE THOMPSON
Water Private: Cistern: Well: Well Permit#:
rPercolation Rate: 35 Limiting Zone: 6 ft 0 in Description GROUNDWATER •
%Ground Slope: 0 Dir: Soil Suitable: (Y/N) N
Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 802 square feet
or Absorption Bed: 1044 square feet
Actual Installation
Septic Tank: lccr gallons Absorption Trench: 93(=, square feet
Absorption Bed: square feet
Design Type: C),
NOTICE
The issuance of this permit does not imply compliance with other state,county or local regulatory or building requirements,nor shall
it act to certify that the subject system will operate in compliance with applicable state,county and local regulations adopted persuant
to Article 10,Title 25,CRS as amended,except for the purpose of establishing final approval of installed system for issuance of a
local occupancy permit persuant to CRS 1973 25-10-111 (2).
This permit is not transferable. The Weld County Department of Public Health and Environment reserves the right to impose
additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the
fmal inspection of the completed system by the Weld County Department of Public Health and vironm
X 11/?-01
Env ronm al Health Specialist Date
Form:S_FINAL
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