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WATER'rAP ASSIGNMENT
FOR VALUE RECEIVED, I/we hereby sell,transfer and assign to ter fb e Family Otri stian atm},
, one 1 water tap in the CENTRAL WELD COUNTY WATER DISTRICT, on my/our
property described as follows situate in Weld County,Colorado,to wit:
>4)/ „" clFF ATTACHED OH= "A"
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IT IS UNDERSTOOD that these taps were purchased for the above described land and may not be transferred to other
land, without express,written consent, in addition to the below consent, of the CENTRAL WELD COUNTY WATER
DISTRICT. I/we further authorize the Secretary of said District to do any and all things necessary to effectuate this
transfer on the bucks and records of said District. I/we hereby state that all water rates and charges and other monies
owed to the District have been paid and if not,shall be held out at the closing of the sale of my/our premises.
IN TESTIMONY WI I RR EO, I/we have set my/our signature this 30th day of
,7an try ,20 06
✓'" SELLER: Jchn D. Black
;O.aw' s �4,t _ •-
i° SRLLRlt: C. Black
Mb:b:RICH TER AGREE to pay any and all charges hereinafter levied by said District for said taps and to abide by all
regulations adopted by said District.
CCIsP'FL2D:
ILL.,, Badly tian r 4 J7 U
.�l.0. ,.tAn�„ Y4.r..,f f.•- .. /!�.*h,oC f c(
" BUYER: j r jams Brinttn Bret
4951 Soh Avow, Firestcre, W 20504
"BUYER:
CONSENT TO ASSIGNMENT
I. John W. 7.adel, General Manager of the CENTRAL WELD COUNTY WATER DISTRIC"I. Hereby consent to
the above assignment on behalfufsaid District,
BY; W.
Z
N W W, Z GENERAL MANAGER
DATE: 0/ 1/4,4
" TO PERSON EXF.C'U7'ING THIS ASSIGNMENT-NAMES AS THEY APPEAR ON 'I'I'I'I.L MUST BE TYPED
AT THE APPROPRIATE SPACES, FAILURE. TO DO SO WILL NEGATE THIS TRANSFER. TWO ORIGINAL
TAP ASSIGNMENTS MUST BE COMPLETED AND SENT TO CENTRAL \VELD COUNTY WATER DISTRICT
FOR DISTRICT CONSENT.
2007-0980
EXHIBIT "A"
Lot A of Recorded Exemption No. 1311-28-2-RE1829, recorded April 17, 1996 in Book 1543 as
Reception No. 2486205, being a part of the North 'A of the Northwest 'A of Section 28, Township 2
North, Range 67 West of the 6th P.M., County of Weld, State of Colorado.
EXCEPT parcel deeded to the Farmers Reservoir and Irrigation Company by Deed recorded October
30, 1909 in Book 311 at Page 410.
EXFIIBITA United Title Company
Exhibit A—Legal Description File No.U0006685
WELD COUNTY HEALTH DEPARTMENT
1517 16TH AVENUE COURT, GREELEY, CO 80631
(970) 353-0635 EXT 2225 FAX (970) 356-4966
Permit # : SP-9700006 Sec/Twn/Rng: 28 02 67 Status:
Permit Type : RNEW C-commercial, R-residential + NEW, REPair, VauLT
Applied: 01/06/1997
Parcel No : 1311 28 000043 Issued: 05/12/1997
l/OCZA% Finaled: tinting'?
Location : T LUPTON
Legal Desc : 20414 N2NW4 28 2 67 (2 . 7R)
APPLICANT BLACK JOHN D & SUSAN C Phone : 303 . 659 . 7139
7812 WCR 17, FT LUPTON, CO 80621
OWNER BLACK JOHN D & SUSAN C
1124 ROCK SPRINGS ST, FORREST PARK GA 30050
SEPT-INSTL TRIPLE "R" BACKHOE SVC Phone : (970) 440-0200
P .O. BOX 145, LYONS CO 80540
Description : HOUSE
Commercial (Y/N) : N Residential (Y/N) : Y Acres : 5 . 00
Number of Persons : 2 Basement Plumbing (Y/N) : Y
Number of Bedrooms : 2 Bathrooms-> Full : 2 3/4 : 1/2 :
Water Public (Y/N) : Y Utility Name : FORT LUPTON
Water Private (Y/N) : Cistern (Y/N) : Well (Y/N) :
Water Permit No:
Percolation Rate : 34 . 0 Limiting Zone : >08 ft 00 in Desc :
96 Ground Slope : Dir: Soil Suitable (Y/N) : Y
' Engineer Design Req' d (Y/N) : N In 100 Yr Flood Plain (Y/N) :
Minimum Installation
Septic Tank: 1000 gal Absorption Trench: 534 sq. ft .
Absorption Bed: 696 sq. ft .
Actual Installation
Septic Tank: j00 0 gal Absorption Trench: — sq. ft .
ll Absorption Bed: ! sq. ft .
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 Health Department 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 final inspection of the
completed system by the Weld County Health Department.
X 12frn45mA
Environmental Specialist Date
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