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Home My WebLink About20031588.tiff COLORADO DIVISION 'F WATER RESOURCES 818 Centennial Bldg., 1313 She . i St., Denver, Colorado 80203 PERMIT APPLICATION FORM RECENED Appl cpion must be complete where ()CIA PERMIT TO USE GROUND WATER '� t 7 applicable. Type or (h' I A PERMIT TO CONSTRUCT A WELL Cj02 prin' in BLACK FOR: (X) A PERMIT TO INSTALL A PUMP Q� INK.No overstrikes aG5pUACfS or erasures unless ( I REPLACEMENT FOR NO. wy'{NTE ING1NEER initialed. ( ) OTHER p11L0. WATER COURT CASE NO. (1) APPLICANT - mailing address - FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMNCC4 / J (.4:'S P /:(50 9650 NAME %�C/J2 G!/`-1 c/ �2c c v.; (). . '.co�' 7 rr�� Receipt No. � - �S J/ STREET Vim. /&o,K -.13 Basin Dist. CITY 2e9 Sc7//' do gel scr (State) (Zip) CONDITIONS OF APPROVAL TELEPHONE NO. `2c:97— 781‘.11 This well shall be used in such a way as to cause no material injury to existing water rights. The (2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant that no injury will occur to another vested water �� right or preclude another owner of a vested water County right from seeking relief in a civil court action. /Yr of the / t e '''A, Section 3.2. Install plain(non-perforated)casings*Sn ground Twp. .7"�_ /Y , R n S Yr- P M, surface down to a minimum depth offes g. _lL E ,v, '^ and properly sealed to prevent the pumping or appropriation of tributary waters. 'd). 3) WATER USE AND WELL DATA NI _...- Proposed maximum pumping rate (gpm) %.- Average annual amount of ground water / to be appropriated (acre-feet): //-- —/ Number of acres to be irrigated: .C�'SS 7,4 / Proposed total depth (feet): <2..5_d Aquifer ground�water is to be obtained from: 1 / Owner's well designation GROUND WATER TO BE USED FOR: ( I HOUSEHOLD USE ONLY • no irrigation (0) (X) DOMESTIC (1) ( ) INDUSTRIAL (5) 1 1 LIVESTOCK 12) ( ) IRRIGATION 16) ( I COMMERCIAL (4) ( ) MUNICIPAL (8) ( I OTHER (91 APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) 9000'7 PERMIT NUMBER JJ O (4) DRILLER '977 �ame ?,•/ ,1, _ DATE ISSUED SEP C 06/� ``� " - f//� Ale, EXPI RAT I ATE C 0 4 Street/ /o.--/e� o��'- O�" 27 �Cft., Cit �/-PP/ C°�, y Y �!✓�/ D ' J:LY,ISTAT N G I N R (state) (Zip) 2003-1588 Telephone No.. s.f FUcry c"6 Lic. No. /9 BY f W LLD LOON ry HEAt-Ill UL I'AIc I MEN ! 1516 Hospital Road n Greeley, Colorado PERMIT NO. �!i 't.' Ph. 353-0540 7 7, ^ Application for permit to Install, Conslnict, nn Individual Sewage Disposal System, 215q - 7823 , 1 , t-, _ • - c-L, "-Phone r `^ ' ' -1:7.1.14( Owner L- r I d k (-1/). .1 C G Cf1 Ad boss /' . r 1 ' J Direction to site: Hwy Rd. N—mi., E \\mi., S_ml., W—mi. Pd 5 9. q' k el 4 j (S . ot &A7 Le ath e) Legal Description: Pin NYZ P1 C.i(J Sec.'fl, T_ LN, *.' W Subdiv. Lot ©Ik • General Information Dept. Use Only No. I3edrooms 2 No Persons 4 Pere. Rate (Avg. of 3) JU L'i•--'-�• No. Baths j basement I)lurubing P) f) Soil Type •S:02 -_-.+-4-1 Lcc' '- Size of Lot (., '2 r, •R Q A : I-I,O Table Depth_ ( Li— i 9't H,0 supply lif well give depth) ,;>r1•? C —! ! �0 - Lot Grade C E3z 7, New Heine Mobile Home Modulo,. Acid'n Requires Engineer Design Yes No Type of sewage disposal requested: - ---- If yes — reason___ • Septic lank __)A./._ Pries. +1_+ *Ger sicm C- � —_ Comments Other 'r1,ls is to cerlfy- 6Y : Is NOT wi-thin goo' RA61ic Sewer)( ••-•#z=--- J Installation Instructions: (Minimum Requirements) Septic Tonk L,t'x)-i Gals. Absorption Trenches • 4-CC Sq. Ft. or Other_ 1 p Seepage bed r"3c' Sq. Ft. Special Instructions 2, 6-4 ! `-r i /as r.(Lira L 2 u,.<.(.t.2.,, try At {o li ✓.,. rlss:V--s^.6 Scs-( (-1-4e}--- This system will be cnnslrurledd rind installed in accordance will, tl,e above specifications and regulations re- garchnq individual sewage disposal systems in Weld County, Colorado This permit shall evl'iie at the male lime (IS the building Derail) nr, if in kidding permit is issued, the permit shall expire 120 days after its i;suniice if construction has not been commenced C r-: Dale: JO ' 3 -7 7 ownr.r:�`;/� . Applica ,l The plans and specifications as shown are approved pending payment of permit fee. Date: t c( ar.;/7 -` Sanilonun � (,..\ The shove system, inspected curl band In comply will) plan and description. Systems Contractor: -..-�_._ Dole: o/S775',((�� Sanitarian: -7 7 ari a Engineer Review: Muir) I SignolureI r'ermit Fee: $ ..6 n 0.9. Received by: Ai( L t'- E. I ., i , .lr Date: 1 ( 2 i Hello