HomeMy WebLinkAbout20061087.tiff . XT-25-2005 TUE 02:03 W .PM D CO HEALTH DEPT FAX f NO 97,Q,,304 6412 P. 32/03
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Application for permit to inatell constxflct; an'T 'b" J Sewage pisposal System.
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owner t. (�I"r.LY� F,3•. , 1: ;,-, - i. •' " . AdaFeB i' '� r, � ,1 YW�'^h1 5 t� .Phone '�-:^r"";,
Directions to site: Hwy r I $td. ,I^ N ',dt�',ME mi,. S rid, ,W.mi
' 'Legal Description: Ptn il'%'a'. seq.-t4-# i''' Ti 'r N 'Alas45iz ily-thyann( Lot'-. B1k =
6.1
General -Information �� De to Use Onl A('
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No._Bedrooms .. ' Na, Persons ' r� m rate i.(av of 3) D rti-..(I
N Baths i :1 i Besero t plunbingrF't,,ir.
'. -I/ Soil. Type , a,,w.�
at. e.) of Lot SS I i I �{, ,j-'4 t.r 0 - , .... ..' iq ,fi, u20'Table Depth — >ri .
H2O supply (If well give depth). , lie '1 t\41cen , -;ry}^. Lot Grade ''>t
'New Home Mobile Home i Modular- *Elitism ' Engineer•Design Yes x No
Type, of sewage,.dispose'L,requested::' If YES-reason:_
Septic tank'v_,Privq Other Comments:
if that the system is'1N0T within G 0 ft. of a public sewer
This • - .
is to certify Y p I Instaltation ;instruct ions: (Minimum Requirements) i'., .
Septic Tank 7j'Q kcals. Absorption Trenches Ak,ki Sq. Ft.
Other cr
Special instructions ,_ •_
Seepage Bed , '`J�C ' Sq. Ft.
This system will be constructed aria inecklL,ed in accordance with the.,above specifications
and regulations regarding indiva'dual sewage disposal systems in Weld County, Colorado.
This permit shall expire at the same time is the. building permit, or, if no building permit
is issued, the permit shall expire 1'20 days after its iesusnce if construction has not
been'commenced. ;
Date:` .`..+ .,l i l Owner':•, .�,. M.,< .1 ."l,'.Sd.:.. t:-... . .
APPIt
The plans and 'specifications aa', shoten are approved pending payment of permit fee.
Date; 1�9�T9
✓� � "�F/ �
S"aniLan.3n:
The above system inspected and found-to coMPI:Ykwith ,plan and escr ttdou.
Systems Contractor: i sates / � a
Sanitarian: ' llil ZVw 1��7W
Engineer .•Review. '
(Date)' (Signature)
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Received shy: � -!'€. Ati � '7� v .! , Data; 4,;,,,
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2006-1087
XT-25-2005 TUE 02:04 FM WEIR CO HEALTH DEPT FAX NO, 97.0,304 6412 P, 03/03
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DETACH AND RETURN ABOVE STUB WITH REMITTA aR CYCLE 2 -^ 03027
Account# Service Address Billing Period Bill Date Due Date TOTAL DUE
3027 5491 SAGE CT 08/21/05 to 09/20/05 09/20/05 10/15/05 154.97
Previous Current Mutt' Usage Yr A
Date Read Date Read Mu g Ago Cd Description Charge
PREVIOUS CHARGES 166.16
PAYMENTS THROUGH-09/13 166.16
BK Backflow/Cross Conne .00
08/15 200570 09/15 269418 (,AT 68848 12486 CU WATER 154.97
Little Thompson Water District _ Current Charges 154.97
TOTAL AMOUNT DUE $154.97 I
**** Please remit payments to: 835 E HWY 56, BERTHOUD, CO 80513 ****
Previous balance due upon receipt . *SIGN UP FOR ELECTRONIC BILL PAY*
*A 11 Penalty will be added to delinquent accounts.
Rates :
Residential 5/8"Base =$16 . 50/mo Arkins 5/8"Base =$24 .20/mo
0-25, 000 =$1 . 71/1000gals 1-25, 000 =$3 . 30/1000gals
25, 001-40, 000 =$2 . 15/1000gals 25, 001-40, 000 =$3 . 74/1000gals
>40, 000 =$2 .20/1000gals >40, 000 =$3 . 79/1000gals
Legend:
Cd - Code Little Thompson Water District
CU - Current Use (gallons) 835 E. Hwy 56
MC - Miscellaneous Berthoud, CO 80513
CR - Credit 970 . 532 .2096
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