HomeMy WebLinkAbout20051479.tiff )
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) -PLEASE RETURN TOP PORTION WITH YOUR PAYMENT--
LEFT HAND WATER DISTRICT
P.O. BOX 210
NIWOT,CO. 80544-0210
(303) 530-4200
www.lefthandwater.dst.co.us
ACCOUNT NUMBER DATE BILL MAILED SERVICE SERVICE NUMBER [ DUE DATE
Lw FROM TO OF OAVS_
p7n
`PREr�q�/f{0Cl5 EADfNG P1NIMfc2D1NO 4Ur�1f' S2I5 1) 51512 4DESCRUPF1ON °61414MOUNTDUE
1,878 -- 1,892 145100 Last payment received 05/11/2004 147.84 CR
if your present reading is a 0,your account was estimated. 1 00
jI WATER BASIC FEE 16.30
} WATER USAGE 44.22
ACTIVATION FEE .00
SHUTOFF CHARGE .00
00 1 MISCELLANEOUS .00
i
SERVICE ADDRESS P. 1 TOTAL AMOUNT
4702 PEAK VIEW ST 1 DUE ► _ _ 60.52
Yoir Water,Jsage Rate is:300 See TabTabibillil84ANT INFORMATION
300 RESIDENTIAL 330 DUAL SYSTEM 3�xCEBSA8L, C 6,,}r
1st 4.000 2.68 1st 4,000 2.68 3.70 ALL USAGE X000 - 1'l.'.• 1
Next 30,000 Next 16.000 3.35 Next 8.000 3.35 4.19 Over 12.000 5.60 330�QlLL7tPLir tiOUS8Y (�
Over 50000 k.... n t---u 1 �� 5 i !: C. "C
3.70 AU_USAGE LI
o _ WATER 0000 GA) - . ri
$ ' Mlar Jun J.
_ Mg Sep Qd Dec 181 Te6 t‘ ltpr Mlay
v` See Reverse Side for Important In ocmataon
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-r I SE RETURN TOP PORTION WITH YOUR PAYMENT-
ATTENTION-NEW RATES NEWSLETTER UPDATE-As required by State Statute,the
WILL BECOME EFFECTIVE District Board adapted new Director District boundaries
FEBRUARY 1,2004 January 15,2004 to ensure equitable representation of
voters.Please call or stop by our office for a free map and
legal description or other election information 0
LEFT HAND WATER DISTRICT (l]
P.O. BOX 21O ut�
NIWOT, CO. 8O544-O21O oi
(3O3) 53O-42OO c/ f N
www.lefthandwater.dst.co.us w.lefth andwate r.d s t.co.u s
30
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ACCOUNT NUMBER DATE BILL.MAILED SERVICE SERVICE 1 NUMBER DUE DATE
FROM TO OF DAYS
2996.01 01/31/2004 12/29/2OO3 O1/28/2OO4 3O 02/21/2004
PREVIOUS READING PRESENT READING UNITS USED DESCRIPTION I AMOUNT DUE H
2,541 2,546 5,000 Last payment received O1/12/2064 37.80 C
If your present reading's a 0,your account was estimated.-
.00
20Ct0 -- — --- - WATER BASIC FEE 15.00
1OJ00 WATER USAGE 13.05
J
Inn
ACTIVATION FEE ,OO
U _-I1 L _ ` I n I 1 Il SHUTOFF CHARGE .OO
Feb bra Apr Map Jun Jul Aug Sep Od Nor Dec Jai MISCELLANEOUS .OO
Water(1000 ggaal))
1 SERVICE ADDRESS ' 4652 PEAK VIEW ST TOTAL AMOUNT
DUE lo28.O5 )
Your Water Usage Rate is.3OO Please see Rate Tablebelow. — ----1
IMPORTANT INFORMATION
31O Commercial 32O MultiWe Housing 33O Dual System
300 Residential
1st 4,000 2.45/th All Usage 3.704h AN Usage 3.70/th 1st 4,000 2.45/th
Next 16,000 325rth Next 8,000 3.25/th
Next 30,000 4.10/th Over 8,000 11.20/th
Over 50,000 5.10/th
See Reverse Side for Important Information
WELD COUNT% DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, COLORADO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
STATEMENT OF EXISTING SEPTIC PERMIT
Permit#: SE-0400072 Sec/Twn/Rng: 09 01 68 PERMIT
Owner: LEASE CHAD Applied: 05/25/2004
Applicant: LEASE CHAD
Parcel#: 1467-09-1-02-007
Location: 4652 PEAK VIEW , ERIE I-25 SOUTH TO HWY
Legal Desc: SA-8A PT L8 scorns A CRES DESC AS BEG NE
COR SEC 9 1 68 W680'
Description: HOUSE
Commercial: N Residential: Y Acres: 3.83
#of Persons: 3 Basement Plumbing: Y
#of Bedrooms: 3 Bathrooms - (Full): 2 (3/4): 0 (1/2): 0
Water Public: Y Water Source: LEFT HAND
mater Private: N Cistern: N Well: N Well Permit Number: N
Septic Tank: 500 Tank Material: CONCRETE
Absorption Trench: 0 sq. ft.
Absorption Bed: 250 sq. ft. Year Installed: 1968
NOTICE
The property owner/agent has certified by Notary Seal that the above described septic system is in fact installed as described,and
exists at this time on the parcel identified above by the parcel number and/or legal description,and further states that the system
IS/IS NOT in good working order and to the best of his/her knowledge IS/IS NOT failing to function properly.
The property owner/agent further understands that any falsification or misrepresentation may result in the revocation of any permit
granted based upon this information hereby submitted and in legal action for perjury as provided by law.
The Statement of Existing Record relies on information the property owner or his/her representative provides,under oath, indicating
current status of the system and representing to the best of his/her knowledge that the system IS/IS NOT failing to function properly.
Issuance of the Statement of Existing Permit for any system does not constitute assumption that the site was evaluated or inspected
during any phase of construction by this Department to meet regulations.
x*6bl/ I t'/1/t
Environmental Health Specialist Date
•
Font:S EXIST 50400N'%
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
.-. GREELEY, COLORADO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
STATEMENT OF EXISTING SEPTIC PERMIT
Permit#: SE-0400095 Sec/Twn/Rng: 09 01 68 PERMIT
Owner: LAFFERTY MICHAEL E Applied: 07/21/2004
Applicant: LEASE CHAD
Parcel #: 1467-09-1-02-008
Location: 4702 PEAK VIEW, ERIE CO 80516
Legal Desc: SA-8 PT L8 SCOTTS AC RES DESC AS BEG NE C
OR SEC 9 1 68 W680'
Description: HOUSE
Commercial: N Residential: Y Acres: 3.53
#of Persons: 1 Basement Plumbing: N
# of Bedrooms: 2 Bathrooms - (Full): 1 (3/4): 0 (1/2): 0
Water Public: Y Water Source: LEFT HAND WATER DISTRICT
/ater Private: N Cistern: N Well: N Well Permit Number: N
Septic Tank: 500 Tank Material: CONCRETE
Absorption Trench: 0 sq. ft.
Absorption Bed: 1000 sq. ft. Year Installed: 1970
NOTICE
The property owner/agent has certified by Notary Seal that the above described septic system is in fact installed as described,and
exists at this time on the parcel identified above by the parcel number and/or legal description,and further states that the system
IS/IS NOT in good working order and to the best of his/her knowledge IS/IS NOT failing to function properly.
The property owner/agent further understands that any falsification or misrepresentation may result in the revocation of any permit
granted based upon this information hereby submitted and in legal action for perjury as provided by law.
The Statement of Existing Record relies on information the property owner or his/her representative provides,under oath,indicating
current status of the system and representing to the best of his/her knowledge that the system IS/IS NOT failing to function properly.
Issuance of the Statement of Existing Permit for any system does not consti to assumption that the site was evaluated or inspected
during any phase of construction by this Department to meet regulations
x
nvironmental Health Specialist Date
Form:S_EXIST
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