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Home My WebLink About20011587.tiff y. FVW/1 XY—a-..r >/'v a��y /m / : ,1 ./ a :1;;,,..,f;,,,,,\;;;;-\ i / },� '.. n. '4 Y, m n .. d� t+g_' 4' df... is � ftr ; il. {•' . .ar"1 �T�j (il � �`�h ♦P ! F Oaf, oafs. 4, • r *•••i r <•fr s et': 44e rL r,.r ai. Sk,l , I•gt- txz<yi' �:A' 4 r ,e < W 1 e„ r i ; t ,••• . >, op f j , ff Y 4 g; ,3 Y + Y , �•A c t. e et a, r a n J V J, a eex r., vex �.r a 3 ga'x<a �, wb' jrJ ' '',1 ''�."" q.A �� JTa oat r��d`0rd'JQ��a� w ''11 a ,n,° w• w qf1l��t .p o w \ r, 't §V �: w'I •'le W l +(t • a >J , ®w.tlpl �..®® J® ® alit �' t Y{r ��• W f ��}a �.M�N�.Uv Vlti'IiLN�2Mn.N�/U�'WvVWVI�`.VLivl.. r..�. �V�.,v:_. .JU.. i_..•��: _ `._ 4_r.. -� _ _ , �i- .._. _ _. v INCORPORATED UNDER THE LAWS OF THE TERRITORY NOW STATE OF COLORADO t 4 u s , nuM c '� L !� ..441:' ® .aC' .�r �. at {I I uE l y ® ig tier 1n t ms �r 65 s it,t*. @j st.I,j^aP a. a '�I^rtyti,llt rt �� nrJ �J i �1 t ll a ,..r WWII �/ • ?k� V ✓'Phi � 1 ' n ) ' `0i 4 f+ n atiQDith�� ` a a — tea tg.', ,!!!,!!!�►►► �y that � =CAPITAL,"STOCK t2.0 060 t -fnl l °De sd d►°� onto C�Px tftr uth V. Hause and Laurance G. Hause-- }h<4is the owner of (cit.' • t. --Sixty-five ,Shares of the Capital Stock of *„'° ( 0 4 The Fulton Irrigating Ditch Company, ci '° .; 1 (, ®= transferable only on the books of the Company on surrender of this Certificate properly gk. ' t" k® endorsed. {. Y" No transfers of stock shall be valid as against the Company so long as the registered homer thereof shall be indebted to this Company upon any .11`y �r >J - past due debt either as principal. security or otherwise. The Company shall have and retain a tint and valid den upon all shares of stock of each stock- i r AL�yti�) - holder ol aas security for the payment of any sum or sums for which such stockholders shall be Indebted to this COMPARE, whether as principal, surety or t pe, IN 2 Whoever appears to be the bolder of this share of stock upon the elect book of this Company, shall, while so appearing, upon payment of the ce 1 equal and ratable share and portion of the entire cut of operation, maintenance, reconstruction and all expense assessable from time to time against it. j - this share, agreeable to the provisions of law and the action of the Board of Directors. be, without any other or further charge, perpetually entitled to <a{a, G7 J the one-aeveoty-two hundredth part of all the water, now or hereafter, appropriated from the South Platte River, or any other source, and turned In at C. ,,1 the headgata of this Company,subject always to the state of the water In said river as affecting the ability to secure the full appropriation for such ditch, as a perpetual water right for use by such holder, for the purpose of Irrigallor, during the Irrigation season, agreeable to the laws of the State !a 6'° rs< ;'a _ of Colorado and the ruin and regulations of this Company. 1 I I , I I e® 'Ph 41 .fin I:II tinuse Th1Terenf, the said Corporation hes caused this Certificate to be signed by its duly Sat t'ie 7.4 authorized officers and to be sealed with the seal of the Corporation at Brighton, Colo., this B,�Q ! Ma 87 gt; A.D. 19 ' N S♦r^?t ifs/ i �` I .��—vc2 et ..2.t, O `1 / aECRLTAfle PRESIDENT ,,[��Iy,. J 1t '2 Mh rl/A � l�Nl/l^ r fZ,l'rl/� t- l ^rlr� fr • 5° ". .• l'l rliY 11 'l In 11 ., lA rl1 rl1^I' t 4t1IV ,r ..G = Eli,� � b , " "'" z $2.11 � �0D Y r.r - r,' r "a,r S''ta�y+t b`+i 1° ry rr 17 a$i '''r re/` t. ��` i�' el ry. rql'^-j.Yt r;$ '; ` ;ir �,. r Fk, _ ��I,r 41,1�F ? � W kr 0 '-W �' V: ..1/ "- I :I.:;,„6,,!,-,hi k `-it \1 , k e i � (. I 4. f.11,--: {I '�( F : C y `fr +.a4v rc0YI I '✓!nF it,gAri nd! I -" J . 1 1r vy un�lam4v/lun ti 1 11 '� Ia!'-N � r. elb r�i'$A�r'1 tic ri�lt6na n 'd r'i_:I 4f: n i `(�� 1'11t €;l1� in't fR•f - •.. '��>� ? t4L�.� '° �' �' . 1 \! r t15� t r :y_ .�,' N -: , ,itt`-'1 tV� �� .. ��- _�. 't�1 11 1 t �I i t r I I 1 ., '. ` • � �- '• �i l' C �E�]`(�^i' R, l `tn; 1 ,1 if- kc`— . f � Ri C " • Ft ,! _�� 1 ' `� F R 4� *, ' 1 I r 1Y;?-_,t r 777 4 ,„,. p t J as " mil \ ' �� A 1 1 tr�`I I __ ,„ , ,L„,„ _ .\..„. i � k `, N -. Z (`� ,} rkrl till 1111 �r\�I Il��r' '��, ] iY... - �j-r<r �41V a -- N A 5 I 1 1 le } 1+�. :�" J C Pxi �� . y �� —"V f l�� / "a ,111 ( ! ��1t� 111( c. Ili � � IF t- It of it': 4�(, 11.7 //11 �r w 4 1 j T ( ,_.i I ; tl I ��t�� r111 I�lll('II UIII��`, t1" '7 t\� �yN.rT � 3 ±e ;\ OF The Fulton Irrigating �t, 1101 iIl r � irl iii li y� cvi1 �'i �� 111. ) ))r�r ��IOW r) ) \ awn `� .� s ; Ditch Company ) k illi. 7 I �'( � , j 1, 1 L. °�-'F � ti F- � a I r , j • \ o,s��l` ) Ys°j IIII' �1i', rr ' 1 iI�'i � 1t jg': Al 1/2,\ .1,( 7 - \\N( " 1 ,1,11) ;ill' ViI)) ,,)1;/;')jil I)/I;‘)::`,:ifici:J.,I' ..\ 1,'C'Ld , .� " 7 11(1 Ali � r� 1 � 1 f1l F � 3; _ }% , C1.;),-_1(:,(11-1-1)111tv,27.1-1,111:1/1.1:)11)}ig:1111.1::Nici: • H' 1111 -� � hj` � N3AJWWII)N JIN NOJMLYi A1N040/IYM)lIYFI)w 1't'F1 /' 111'`/11I v Id M)N/ lY II'l)J)N/.10)'Yl , -` �) '- �YC M JIYN) ( 1 NO C) NOJ($IV {i+ 1 1 7 ' V I�I !/IO/NlM by101 )NI NO/O N]/(/N�d� JN)NNISY dN/l0)N1/Y++N tIit 7,2119// AA`^�e�: F'T'w 1 11 I' C 1 `CI .-s I�M�''. /: P 4�r,"'*'1-rc^R, ",^f� ! ''Ft'*^"�pF!' „Y4 1 j �� l -1l,,�eUgi tl � l•J � V rJ'd} U� °1!hi .'r j :,� ' [� � �., otre1Pnyy MCI o d Jr�Ate '}?y (!cel: r'OrCKEL CO DrHVrn 337604 TTHa STATE OF COLORADL For Office Use only aws•id OFFICE OF THE STATE ENGINEER • 03/92 • • ate Centennial Bldg.,1313 Sharman St.,Denver,Colorado r702a3 ess ' ' • • • . • OWNER'S COPY. FOR INSTRUCTIONS,SEE REVERSE SIDE. . STATEMENT OF BENEFICIAL.USE . . • • .RECEIVED • WELL PERMIT NUMBER • 20138 R R . ZU 18199? 1. WELL OWNER R LA.dIrk V. 1-4Oa.45a ',Km ol �te" . La.u. n ra. ce G NAME(S) �.�— ad r s ,, ..v_ H oath 5 � �A3se ATIVISENBINEER Mailing Address 2003 Sal slim Dr. • City,St Tip • Sou 1der., Co. -80304 •Phone ( 303) 442-0073 •- i�h-9g 2. WELL LOCATION: COUNTY Weld OWNER'S WELL DESIGNATION (Address) (CRY) (Stat�e)),i-'f tap) 14W 1/4 at the SW 1/4, Sea 20 Twp. 1 i2�N. orO8., Range 66 ❑E *SW. 6 P.M. Distances from Section Lines 1 345 Ft from El N. eat Line, 800 Ft. from ElE o2W. Line. 3. The well Is being used forthedoilowTg purpose(s):_ Crop irrigation . 4. Water from the well was first used beneficially • under this permit number, for the above described purposes on 11-4-97 19•_, (Do not report a date which Is before the Issued date of this perms) -C. The pumping rate'daimed is 1 An gallons per minute. - •' - , • . •6. The average annual amount of water diverted is 120 acre feet. • 7, The land area irrigated (watered) by water from this well is: 80 X t�X Acres or ❑Square feet, • (Number) described as: Mk of the SW 1/4 of Sec. 20 Twp. 1 N. Rao.. 66 W 6th. PM ,• . (Legal Doscnpuon) - or as Subdivision Lot(s) . Block Filing/Link 8. Well drilled by: R & R Well. & Pump Inc. , , . LIe. No: 857 • Pump installed by: R & R Well & Pump Inc. - Lic. No: 857 , • 9. Meter Mfg. by U- Croats; Serial No,: 97-8-200711 'Date Installed: 11-4-97 , I (we) have read the statements made herein, know the contents thereof, and state that they are true to my (our) knowledge. (Pursuant to Section 24.4.104 (13)(a) CAS., the making of false statements herein constitutes perjury . In the second degree and ispunishablg as a Class 1 misdemeanor.] L, 10. Name/T tle (piaaaput₹m h or prat H.•�<//o.•+�fS .r [On re C tea .r '2 •v-s" Date OWNERS Roth & Laurance Hause 1` �� ` 11-13-97 FOR OFFICE USE ONLY . Accepted that the:conditions of approval EXHIBIT Os stated on the well permit are complied with. I Z • 4T .. r- . 4 tif ' . . `0 JUN 2 1 Zen State Engineer Sy ` Cate Court Case No. Div. 1 Co.Co. WD �<Basin. . MD Use _ • 11/09/2000 Ind 16:07 [TX/RX NO 5314] 21003 r- 1r. ...ft., e - • L., acme, COLORADO DIVISION OF WATER RESOURCES ac TYPE R OPY OF ACC INK_ un^/•/n' 818 Centennial Bldg., 1313 Sherman St. RE OPY OF ACCE TED '-✓J Denver, Colorado ()0203 JUL 5777 3TATEMENT MAILED ion ON REQUEST. STATE OF COLORADO A p1 COUNTY OF Weld SS. Wks vim*g 1 aukc OM _AL STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD ll LATE REGISTRATION 4LZ!/rLigGQ G s!pa�TTNUMBER 2-01S28 Q LOCATION OF WELL THE AFFIANT(S) Dr ffnher+ 1JD Rause County Well _ whose moiling 335 East Wad�rd Ave •., ^ /� address is _- •✓ •7 --,. ... N ry A of 16e _SW u. swiss 20 3 it e14-4 Twp: _• , ,'.ens ir-W.I P i win being duly sworn upon oath, deposes and says that Ir(they) w(ore) the owner(s) of the well described hereon, the well is located as described above, at distances of 1340 feet from theIIlL__section line and 750 feet from the i v se Douro, Wes} section line; water from this well was first applied to a beneficial use for the purpose(%) described herein on the /6 rrACT aa was.I day of litir ( , 19_2Z; the maximum sustained pumping rate of the well is —Z rte llons per minute, the pumping 7 rate claimed hereby is ✓gallons per minute; the total depth of the well is 46 feet; the th average annual amount .of water to be diverted is � V acre-feet; for which claim is hereby made for j rri JQ 110a purpose(s); the legal description of the land on which the water from this well is used is NWl of the SW % of Sea . 20l T. t Nj ii, 46 We 6.+h i._ P of which BO acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he (they) has (have) ead the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge. COMPLETE REVERSE SIDE OF THIS FORM) Subicrjited and-sworn 1;....),k FOR OFFICE USE ONLY to beft)re me on-this as' day of 27n1 y , 192 /w /qqre•�� Court Core Na. ��' /� • My Ceinm.ission expires: d+r.a.e. )� 1,7a • tja(u I. �• Pr lar. _ Mo.-Day_ Y. _ _ ///`r J • nowa i raa llc Di r. / (ay. /V ACCEPTED FOR FILING B STATErENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: S•c._ .__. .. s. ....._ a. ti. . well Us. -. . . -_ ' Dist. i 2._ Basin —_. , Man. On i e APR 0 61978 C____d � _ _kui ,e- / DATE STATE EER ItY r !� \ 1 'q I -./ t . r„" ° _ / ,i 18( ( ' • 11— -.— . 16 • r SEP G T't°' "Sigiftsutsides------ I a. 1 ° Weft • .. aaaa• BM .. 1 r / �_..— aos 1 5 •x.938 f t ._ ./ .•. � ' � 4' wm L _ _ . . . \ —• ^ , 111 ( ( 1 • !•I -;—T ' ; ti. 19 <wNl !lItc. � �` / - • � Sj/ f- .. • '•� G�J ..„., ' 1 • 1 , Tank .a.) •950 1 1 4" 1 I 1 I Tall f` • �" • • - i I:,P ^fir!" • fa 30 ' 'I . ,, % 29 ' �. r."7: fiCil " -T' .% -.w . _.., „ i . , \ .i -- 1 w---... \ x C7 ) .i, I iroc, 1 , .. usa , , I 1 ! ‘ 6666`. , I v C: I . ae_ '31, I - '. -f . ' ,..7----. \ ` r"' /j .` B r '� r 32 so, `____ � 33 � j . i -f f it • r . BRIGHTON I • L •1. •)1 �.. ,� � • s��///s r(� r ! .y:B '�,r�� Y7Q�-luxe :- ..,....._ • i'.L,°1' 4 .•l' • � l - • 1:. �� a.:: / •i'•. 615 (BRIGHTON! 1617 4T 30• 618 1319 I At TO INTERSTATE 76 5063 fV NE 1 SCALE 1:24000 • 2 .._ 0 1 W U .. 1 L • ISTBATION BY wwJae.T. j OFFICE OF TEE r THIS FORM MUST BE STATE ENGINEER AS PER SUBITTED PRIOR TO THE MEXPIRATION OF THE COLORADO DIVISION OF WATER RESOURCES DECREE GRANTED UNDER r.PERMIT, TYPE OR 300 Columbine Bldg., W-5027 'RINT IN BLACK INK. 1845 Sherman St. CASE NO. COPY OF ACCEPTED Denver, Colorado 80203 WATER DIVISION_ STATEMENT MAILED PURSUANT TO SECTION ON REQUEST. STATE OF COLORADO AFF _ZO (8), C.R.S. COUNTY OF SS' 1963, Lb AMM:nutiU. DAIS March 4, 1975 STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD WEcc we, I PERMIT NUMBER 78501 LOCATION OF WELL THE AFFIANT(S) Robert D. Hause and Laurance G. Hause County Weld whose mailing address is 335 East Woodwart Avenue P.O. Box 155 NW w of ti» SW i , snow. 90 City Keenesburg, Colorado 80643 r«O. _j_�(_) R«,. 66 (_ Ath P.M. (STATE) (MV) (N OR e E o« WI being duly sworn upon oath, deposes and says that he (they) is (ore) the owner(s) of the well described hereon; the well is located as described above, at distances of 1380 feet from the South section line and 120 feet from the WORTH On MOUTH) West section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the 28 (CAST OR Van) day of March 19 61 ; the maximum sustained pumping rate of the well is unk gallons per minute, the pumping ,0 �• . rate claimed hereby is_15 gallons per minute; the total depth of the well is unk feet; the average annual amount of water to be diverted is unk acre-feet; for which claim is hereby made for Domestic purpose(s); the legal description of the land on which the water from this well is used is which totals acres and which is illustrated on the map on the reverse side of this form; that this well was completed in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he (they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge. Signature(s) ' Subscribed and sworn FOR OFFICE USE ONLY to before me on this day of , 19 Court Casa No. W-5027 My Commission expires: Prior. Mo. Day Yr. NOTARY Rwuc Div. 1 Cy. • 62 ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: sec. w, w, w• Ndl use 1 Dist. 2 Bea in Mon.Dis. APR 01 1975 DATE STATE ENGINEER 8Y �,,, 1 r- Well drilled by Lie. No. Pump installed by Lic. No. Mater Serial No. O Flow Meter Date Installed 'Owner of land on which water Is being used THE LOCATION OF THE WELL MUST• BE SHOWN AND THE AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW. This diagram representsjnlrj9y sections. Use the CENTER SQUARE (one section) to indicate the location of the well, if possible. I I I • I I • I — + — + — + — -- — -E — + — I I I I I I — + — + — -I- — + — + — + — NORTH SECTION LIME NORTH r 41 f m - + - + .i z + — + — in N J m I m I ■S. r i z w ,n — + — + (TIE. t + — + — � I I SOUtH SECT ION L IIf E I I - + - + - + - + - + - + - I I I I I I THE SCALE OF THE DIAGRAM IS TWO INCHES E 2UALS ONE-MILE - + - + - -+ - + - + - + - I I --11 M i l e --- I I WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep. 1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm). 1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 ocre-feet. 100 gpm pumped continuously for one year produces 160 acre-feet. r Wn,zg 74 SAT1 REGISTRATION BY THIS FORM MUST BE THE OFFICE OF TEE SUBMITTED PRIOR TO THE EXPIRATION OF THE COLORADO DIVISION OF WATER RESOURCES STATE ENGINEER AS PER ,e--...PERMIT. TYPE OR 300 Columbine Bldg., DCCREE GRANTED NDER RIN T IN BLACK INK. g•, 1845 Sherman St. s W- 02 .OPY OF ACCEPTED Denver, Colorado 80203 CASE ND.5 STATEMENT MAILED WATER DIVISION 1 ON REQUEST. STATE OF COLORADO AFFID6a3UANT TO SECTION 1 COUNTY OF SS' 14Set-4U Id). C.E.S. 1963, AS AMENDED. DATE_Jlarch 4 1975 STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD WEsc NO. j PERMIT NUMBER 78502 LOCATION OF WELL THE AFFIANT(S) Robert D. Hause G. Laurance G. Hause county Weld whose mailing address is 335 East Woodward Avenue, P.O. Box 155 NW V.of the SW u, seauaa 20 City Keenesburg, Colorado 80643 TWP. 1 l _ , RRs. 66 _ 6th P.M. (STATIC) (ZIP) (N OR$I E a0. wt• being duly sworn upon oath, deposes and says that he (they) is (ore) the owner(s) of the well described hereon; the well is •located as described above, at distances of 1444 feet from the South section line and 249 feet from the Ixonen OR SOUTo) West section line; water from this well was first applied to a beneficial use for the purpose(s)os )s described herein on the3]_ (CAST OR WEST) day of December , 19 31; the maximum sustained pumping rate of the well is unk gallons per minute, the pumping r i ate claimed hereby is _ -20 _ gallons per minute; the total depth of the well is unk feet; the average annual amount of water to be diverted is unk acre-feet; for which claim is hereby made for Stock watering purpose(s); the legal description of the land on which the water from this well is used is which totals acres and which is illustrated on the map on the reverse side of this form; that this well was completed in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he (they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge. Signature(s) Subscribed and sworn FOR OFFICE USE ONLY to before me on this day of , 19_ Coun Case No. . W-5027 My Commission expires: (SEAL) Prior. Mo. Day__Yr. - NOTARY PUBLIC Div. 1 Cry. 62 ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: sea. u, %, r, Well Use 2 /� Dist. 2 Basin Man. Dis. , APR 01 1975 DATE STATE ENGINEER BY • Le"' Well drilled by Lic. No. Pump installed by Lic. No. Meter Serial No. El Flow Meter Date Installed Owner of land.on which - -- water it'being used THE LOCATION OF THE WELL MUST BE SHOWN AND THE AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSSHATCHED ON THE DIAGRAM BELOW. This diagram represents rii6a 9) iections. Use the CENTER SQUARE (one section) to indicate the location of the well, if possible. I 1 I ' 1 I 1 - + — + — + — .+. — + - + - I I I I I - + — + — + — + — + — + - NORTH SECTION LINE I I NORTH - + — + �- z + — + - l N J I rn z o I WAin eta r i Z W r-- la — + m + -- + - r w ! I I SOUTH SECT ION LIFE I - + — + — + — -I- — -I- — + - I I I I I I THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE-MIL E - + — + — + — + — + — + - -A Mile - WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 Foot deep. 1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm). 1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. 100 gpm pumped continuously for one year produces 160 acre-feet. ( 'j(f ; ≥\S\ DEPARTMENT OF PUBUC HEALTH AND ENVIRONMENT 1555 N 17THAVE GREELEY,CO 80831631 WEBSRE: www.co.weld.co.us vgige ADMINISTRATION (970)304.6410 FAX(970) 304.8412 PUBLIC HEALTH EDUCATION AND NURSINGFAX(970)304 6420 T ENVIRONMENTAL HEALTH SERVICES(970) 304-6415 COLORADO FAX(970) 304-6411 AUTHORIZATION FORM RE: lA SEPTIC PERMIT APPLICATION ❑ LS.D.S.EVALUATION a SALE OF PROPERTY a WATER SAMPLE I represent for the property located at 2292 Weld County Rd 27 LEGAL DESCRIPTION: SEC 20 TWN 1N RNG 66W SUBDIVISION NAME: NA LOT NA BLK NA I can be contacted at the following phone#'s: Home Work 303-289-8555 Other Fax# 303-289-7707 The property owner can be contacted at the following phone#'s Home 303-442-0073 Work Other Fax# OWNER'S SIGNATURE DATE 3J1.110 I EXHIBIT SEPTIC INFORMATION FORM System" To obtain an I.S.D.S. permit, one must file an "Application for Individual Sewage Disposal at the Weld County Environmental Protection COLORADO Services office, and pay the application fee. A "repair" fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be provided on the septic information form: PARCEL NO.: 147120000022 THIS CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT(970) 353-3845 EXT 3650 PROPERTY OWNER Laurance Hause MAIUNG ADDRESS 2003 Balsam Drive CITY Boulder ST no ZIP R03n4 HOME PHONE 13031 442-0073 WORK PHONE ( ) FAX ( 1 APPUCANT NAME Asphalt Specialties, Inc. MAILING ADDRESS 7321 East 88th Avenue CITY Henderson ST CO ZIP HOME PHONE ( 1 WORK PHONE (303 2R4.R,55c FAX Elm) 2RQ-77o7 LEGAL DESCRIPTION PT N 1/7 PTsw 1(4SEC 20 TWN 1N RNG RRw ACRES 67 SUBDIVISION NA LOT NA BLOCK NA FIUNG NA DESCRIPTION OF BUILDING (ex: House, Mobile Home, Modular, Shop, Office) SITE/LOCATION ADDRESS 77Q7 Weld nnunfy Rd 27 DIRECTIONS TO SITE 1/4 mile nnrth of Weld Cnunty Rd R on east cide of Weld Canty Rd 27 (aka Rucinecc Hwy RS) NEW PERMIT X REPAIR PERMIT $316 $315 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THIS PROPERTY CENSUS TRACT 19.03 RESIDENTIAL YESe COMMERCIAL Cr S73NO NUMBER OF PERSONS BASEMENT PLUMBING YES/se NUMBER OF BEDROOMS NA BATHROOMS: FULL a_ 3/4 NA 1/2 NA WATER SOURCE: PUBLIC YES/en NAME OF WATER SOURCE Private Wells PRIVATE CES) NO CISTERN YES I NO WELL CES1 NO WELL PERMIT# 90138 78501 78502 Hello