HomeMy WebLinkAbout20031268.tiff 1
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, COLORADO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Permit #: SP-0200546 Sec/Twn/Rng: 17-03-68 EMIT
Owner: SHUBERT MELVIN H AND JACKLYN Applied: 12/03/2002
Applicant: SHUBERT MELVIN
Permit Typk: RNEW C=Commercial,R=Residential + NEW, REPair, VauLT
Parcel #: 1207-17- - -
Location: jot eQ
Legal Desc
Description: MANUFACTURED HOME —'
Commercia : N Residential:Y Acres: 1
# of Persons: 2 Basement Plumbing: N
# of Bedrodtns:)Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Publ4c: Y Water Source:KL JTTLE �OMPSON
Water Priv te: N Cistern: N Well: -Is Well Permit Number:
Percolation'Rate RI to Limiting Zone _ ft (p in Description\° t'b14 jR a e1011)‘014-€.
-% Ground lope 1 Direction U) Soil Suitable (YIN)
engineer Design Required (YIN) to In 100 Year Flood Plain (Y/N) tti
From the application information supplied and the on-site soil percolation data the following minimum Installation specifications are
required:
1
Septic tank L D� �N/ ^ hambers
gallons, Absorption Trench U�^J� square feet
or
Absorption Bed q2O square feet gZ
addition this permit (a suNgct to the following addWonal terms and conditions: - --_t�--_
hM 2f� QtYr k.�atll, . ti V&- AD A d k kQ kt W� 1"I U�-ti
.6 6 1K
�e _ iniosikt. i4LiQks q l
NOTICE.
This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld
County Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System
Regulations including failure to meet any term or condition imposed thereon during temporary or final approval. The issuance of
this permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage
disposal system.
This permit is non transferable and non refs)dable. Before issuing final approval of this permit 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 is contingent upon the final inspection of the completed system by the Weld County
--Department o'Public Health and Environment.
R Y 1,)-(laIia
Pam:s PERMRN Environmental Health Specialist Date
2003-1268
I'"`'I'LE THOMPSON WATER DISTRICT 355�
WATER TAP APPLICATION TAP NO:`# Q
TO: Bond of Directors,Little Thompson Water District
--' Application is hereby made for domestic water service to the following describeb property
Legal Owner of Property:
Street Address of Property: i
Town and Zip Code: �c� r, y C` L.
J ;
Subdivision: — Lot No: Block No:
Section. /7 Township: - North, Range: !� West of the 6th P.M. County: •
Applicant understands that if this application is not accepted by the District.or is the event the applicant to withdrew
this application for water service prior to installation,the tap fee will be refunded W applicant,with the excep ' of any actual
expanses which may be incurred by the District in processing this application.
Meter Size Tap Fee
3/4"
"
Y"
Note:
Tap sizes larger than 2" will be charged a fee as set by the Board of Directors.
ij
TAP FEE ' )CU IMPACT FEE SPRINKLER TAP FEE
Applicant understands that property must be included in the District boundaries for service and woes to(unlita complete
written legal description of the property saved prior to tap installation,if so requested.
If application for service is accepted,applicant understands that the water saute is subject to the rules and r adore of
the District"as currently established,or as may be modified in the future by the board of Directors. A copy of rules and
regulations for the District is available for the applicant,if desired.
Applicant certifies that$aal lot grade will be established prior to installation. The District will not be kIsbk for the
eapense a in rdsfifitl if required after installation due to a change,1 gra 7
�-t /'yr
' (Si of Is Owners) (Signature of Applicant)
Serest AOtMar)
L � .� . C � �
F OR DISTRICT OFFICE USE ONLY (Town and Zip Code)
Tap Number: 3 4-4.5 J, Area: _
'.''ap Fee Recd. C, X. ., (Telephone Number)
Land Included in District, _ Direct hereby acknowledges rep ipt of
Meter Book.._. _ S -',5 7i;.)
Map Number:__.._Nude Number:
Date Tap Installed:._ _ -
irk Order N. 1 :l ' tl'L YI.;�f. jii�_ , •
--- District Represamtive Ds>I
LITTL,.. THOMPSON WATER IrSTRICT
Domestic Water Agreement
��r,s r
` .20 —by and tweets
Agreement made this�-----'—
dayof�
.OS e`+ Land Owner, Hereinafter referred to as.U r,and
THOMPSON water distrit. heatter referred to as the District. is u t(se
LITTLE THOMPSON WATER DISTRICT. a statutory rtn
tollowiig terms and conditions, fur the property and water tap shown below:
Legal Owner ol Property..
Street Address of PfOper[V. ---�-�-'-� �L�,yD Tap No:
Town and lip Code
S __._ 3 5_5-
Purpose of Domestic Water Service:
Residential Single Family: Multi-lamily; Commercial; or Other(describe?
WHEREAS the District is the owner offacilitiesfor the purpose of furnishing Domestic Water to viers within said Di lc. t:and
WHEREAS the user is desirous of obtaining domestic water for his property.
•
NOW THEREFORE, the parties hereto agree to the loiiowing:
1. This agreement shall be the binding contract between the User and the District.
2. Uses hereby agrees to pay to the District such sum as may be prescribed from went to time by the Board of Direc as the
water me or charge for such water service. Payments shall start when the District installs the tap and water is av lable fat
delivery. A minimum payment, as prescribed from time to time by the Board S Directors of the District, shall due and
payable regardless of water use.
S. Until paid.all rates.tolls,or charges shall constitute a perpetual lien on and apinst the property served,and any Such lien
may be Foreclosed in the same manner as provided by the laws of the State of Colsaado for the foreclosure of merchanic's hen.
The District shall shut oft or discontinue sees ice for account delinquencies or other violations of the District's Rules and
Regulations.
S. No water service may be obtained except upon propeny included within the boundaries of the District. U 'agrees u
include the property served within the Disnicc,if this has not been previously accomplished.User further agrees t the will
riot permit other persons to use watet furnished to him under this agreement.
5. District agrees to turnith water to User PROVIDED,that the District shall not be liable for loss to User forfailurentodeliver
water because of war, riot, insunection, breaks in the water system or Acts of Gad.The District shall endeavor tolrtpair all
breaks promptly on District lines.
6. User agrees to abide by such ether rules and regulations of the District regarding the use of water as may be ntabl$hedfrom
time to time by the Board of Directors.
7. The user's name and billing address for all statements and notices is:•
j ES" 9O I Li(' t �y
vr."t T CGS; ESQ, "..Q
IN WITNESS WHEREOF the parties have subscribed their names the day and vyj first a ten.
LITTLE THOMPSOILW LR DIs'l (C7 / i��!,�,4, '
f
BY: ___ -tiers
t--
(Signature of Land Owner)
cc"-' L'L'W D Form 520
(Res. April, I98&
Hello