HomeMy WebLinkAbout850763.tiff RESOLUTION
RE: GRANT MOBILE HOME PERMIT NO. 1013 - DARWIN K. AND JACQUELINE
K. BARNETT
WHEREAS, the Board of County Commissioners of Weld County,
Colorado, pursuant to Colorado statute and the Weld County Home
Rule Charter, is vested with the authority of administering the
affairs of Weld County, Colorado, and
WHEREAS, the Board of County Commissioners of Weld County,
Colorado, on the 15th day of May, 1985 , considered the request of
Darwin K. and Jacqueline K. Barnett for a mobile home to be used
as a principal dwelling, and
WHEREAS , said mobile home is to be occupied in an
A-Agricultural Zone District on a parcel of land being more
particularly described as follows:
Part of the S1 Sz NWy, Section 23 , Township 2
North, Range 67 West of the 6th P.M. , Weld
County, Colorado
WHEREAS , the Board of County Commissioners, having heard the
testimony, finds that said request should be granted subject to
the following conditions : 1) The applicant shall apply for a
building permit for the mobile home within thirty days from the
date of approval by the Board of County Commissioners; 2) Prior to
the issuance of a building permit, the owner shall submit evidence
that Central Weld County Water District is supplying water in such
a manner as to be adequate in quality, quantity and dependability
for the proposed use; and 3) The mobile home shall not be occupied
until such time that the applicant has complied with the above
mentioned conditions.
NOW, THEREFORE, BE IT RESOLVED by the Board of County
Commissioners of Weld County, Colorado, that the request of Darwin
K. and Jacqueline K. Barnett for permission to place a mobile home
to be used as a principal dwelling on the above described parcel
of land, which was found to be in compliance with Section 43 of
the Weld County Zoning Ordinance, be , and hereby is, granted
subject to the hereinabove listed conditions.
1. ;i ��� (2 T'- '-r'`G 050763
'PLOO I1
Page 2
RE: ZPMH #1013 - BARNETT
The above and foregoing Resolution was, on motion duly made
and seconded, adopted by the following vote on the 15th day of
May, A.D. , 1985 .
%� /- BOARD OF COUNTY COMMISSIONERS
ATTEST: \MI 44Ali iv WELD COUNTY, COLORADO
Weld County Clerk and Recorder n,
and Clerk to the Board J u ine Johnsgi, Chairman
1 �
BY:,4 0-42-m_Le, try Gene R. Bran ner, Pro-Tem
Dyputy County C rk 7
APPROVED AS 0 FORM: C.W. Kirby
EXCUSED
\\` U Gordon E. Lac
County Attorney f�� l �2%g
i.�`�afi` uL �fi
TO: Board of County Commissioners Date: May 15, 1985
7.PMI{# 1013 Applicant: Darwin K. & Jacqueline K. Barnett
This request is for one (1) mobile home to be used as a principal dwelling
Legal Description of Parcel: Part of the 51 S2 NWT, of Section 23, T2N,
R67W of the 6th P.M. , Weld County, Colorado
Location: Approximately 3 miles northwest of Fort Lupton; north of Weld
County Road 18 and east of Weld County Road 21
The Department of Planning Services staff has reviewed this request and
recommends that the request be approved for the following reasons:
WILL WILL NOT
X Be compatible with the Weld County Comprehensive
Plan.
X Be compatible with the surrounding area.
X Be in harmony with the character of the
neighborhood.
X Adversely affect the immediate area.
X Be adequately served by water and sewage disposal
facilities.
X Adversely affect the general health, safety and
welfare of the inhabitants of the area and the
County.
COMMENTS:
/ " The Department of Planning Services has received no objections to this
U' ` application.
The Department of Planning Services staff recommendation for approval is
conditional upon the following:
1 . The applicant applying for a building permit for the mobile home within
thirty (30) days from the date of approval by the Board of County
Commissioners.
Board of County Commissioners
May 15, 1985
Page 2
2. Prior to the issuance of a building permit, the owner shall submit
evidence that Central Weld County Water District is supplying water in
such a manner as to be adequate in quality, quantity, and dependability
for the proposed use.
3. The mobile home shall not be occupied until such time that the
applicant has complied with Condition 1 and 2 above.
Gloria . Dunn
Curre Planner
FIELD CHECK
FILING NUMBER: ZPMH-1013 DATE OF INSPECTION: May 6, 1985
NAME: Darwin K. & Jacqueline K. Barnett
REQUEST: Zoning permit for a mobile home to be used as a principal dwelling
LEGAL DESCRIPTION: Pt. S1 S1 NWT of Section 23, T2N, R67W of the 6th P.M. ,
Weld County
LOCATION: Approximately 3 miles northwest of Ft. Lupton, north of Weld
County Road 18 and east of Weld County Road 21
LAND USE: N Private road, oil well and storage tank.
E. Grassland, 2 residences
S Turkey farm
W pig farm, 2 residences, Weld County Road 21.
ZONING: N Agricultural
E Agricultural
S Agricultual
W Agricultural
COMMENTS:
Access to the subject property is from a private dirt road to Weld County
Road 21, a dirt road. The 10-acre site is vacant with a slope to the east.
10 residences are located within 1/4 miles.
By: L./Gloria . Dunn
Curren Planner
.WELD LOUNTY DEPARTMENT OF PLANNING SERVICES ZONING PERMIT
915 10th Street MOBILE HOME
Greeley, Colorado 80631
Phone 356-4000 Ext. 4400
IMPORTANT - Complete all items on both sides. Mark boxes where applicable.
APPLICANT PHONE
ADDRESS
OWNER _ PHONE
ADDRESS
59 (.4)C \
CITY - STATE - ZIP LOT ]BLOCK SUBDIVISION
LEGAL DESCRIPTION
/srAP- o� /JO. ;31?-DY-«_ PE X34?
Section Q .� , T N, R W. Total Acreage ," -
Application for zoning permit' is made for:
Staff Approval Board of County Commissioners Approval
Q Temporary Use During Construction O Use Beyond 18 months During Construction
of a residence of a residence
Q Temporary Storage Ei Extension Beyond 6 months for Temporary
Storage
O Accessory to Farm 0 More than one MH as Accessory to Farm
O Accessory Use as an Office O More than one MH as Accessory Use as
OAccessory Use in C or I Zone District an Office
O More than one MH as Accessory Use in
C or I Zone District
0 Temporary Use during Medical Hardship
O Accessory Structure
Igi Principal Dwelling
The above requires an Application fee of above requires an Application fee of
$50.00 ! 100.0Q/
TYPE OF SEWAGE DISPOSAL TYPE OF WATER SUPPLY
O Public or private company: Public or private company:
CF I- .` ii)=Li _CO vrry 1II ^_ ~
t( Septic Tank - Permit #i-1-85CO4,5 O Individual (well, cistern)
Well Permit # _
Copy Attached: YesjR3 No CJ Copy Attached: Yes 0 No 0
DEPARTMENT OF PLANNING SERVICES USE ONLY
ZONING DISTRICT ZONING PERMIT NUMBER
APPLICATION FEE PAID RECEIPT NUMBER DATE CHAINDEXED
APPROVED BY:
0 Staff 0 Board of County Commissioners Hearing Date
ISSUED BY: DATE
' MOBILE HOME BUILDING PERMIT NUMBER DATE ISSUED
A sketch plan is required as part of the application review. Please attach a sketch plan
of the site at the scale on one inch represents fifty feet or other suitable scale to sho
the proposed location of the mobile home, including distances from the property lines and
other structures on the property; access to the mobile home, indicating whether the access
is existing or proposed; location and measurements of any easements or right-of-ways; and
any existing structures on the property.
Sketch Plan attached: Yell No 0
Deed or contract attached: Yesgi No
What housing is available on the property and what is its present use? '1.
How many mobile homes are on this property at the present time?
TEMPORARY USE DURING CONSTRUCTION OF A RESIDENCE N�N
Building Permit Number ' Date Building •ermit Issued
Zoning Permit valid for 6 months from date of issue.
Zoning Permit issued `.
valid from to
RENEWALS:
FIRST - From to
Fee: Reviewed & Approved
SECOND -From to Fee
Reviewed & Approved
ACCESSORY FARM USE _
Type of farming operation on property:
Number of Livestock
' Average umber per year
Acres Irrigated Acre- Dryland
Number of employees now em to Acres Pasture
P y- ' � Full time. Part time:
ACCESSORY USE IN C OR I ZONE _ --------
Alan
Type of commercial or in• •strial activity on property:
Number of employees.
Full time: rt time:
Mobile home will be used for:
IGNATURE OF APPLIC IT
APPLICATION DATE
-
' 7-,g5
BU INC PERMITS ARE REQUIRED FOR ALL MOBILE HOMES IN ADDITION TO THE ZONING PERMIT FOR
°ILE HOMES. THE BUILDING PERMIT MAY BE OBTAINED FROM THE BUILDING INSPECTION DIVISION,
ROOM 342, CENTENNIAL CENTER, 915 10th STREET, GREELEY, COLORADO 80631, PHONE 356-4000
EXT. 4425, AFTER APPROVAL OF THE ZONING PERMIT.
Recorded at o'clock M.,
Reception No. Recorder
DEED OF TRUST
THIS INDENTURE, Made this Eighth day of April ,19 85 ,between
•
D. K. BARNETT and J. K. BARNETT
whose address is 6075 Weld County Road 20, P.O. Box 382, Frederick, Colorado 80530
part ies of the first part,and the Public Trustee of County of Weld
in the State of Colorado,party of the second part,Witnesseth:
THAT,WHEREAS,The said D. K. BARNETT and J. K. BARNETT
ha ye executed a promissory note bearing even date herewith,for the principal sum of
THIRTY SEVEN THOUSAND FIVE HUNDRED AND NO/100 Dollars,
payable to the order of FORT LUPTON STATE BANK
whose address is P.O. Box 228, 605 Fourth Street, Fort Lupton, Colorado 80621
On or before ten (10) years after the date hereof,with interest thereon from the date thereof
at the rate of 15.50 percent per annum,payable in 120 equal instalments of $605.01
with payment applied first to accrued interest and any remainder to the outstand-i
ing principal. ,
AND WHEREAS.The said part ies of the first part are desirous of securing payment of the
principal and interest of said promissory note in whose hands soever the said note or any of them may be.
NOW. THEREFORE, The said part ies of the first part, in consideration of the premises and for the purpose aforesaid,
do hereby grant, bargain, sell and convey unto the said party of the second part in trust forever, the following described
property,situate in the County of WELD ,State of Colorado,to wit:
•
The East 990 feet of the West 1320 feet of the Sts of the S4 of the Nits of Section
23, Township 2 North, Range 67 West of the 6th P.M.
TOGETHER WITH a non-exclusive easement over and across the North 30 feet of the
S4 of the Sss of the Mitt and the South 30 feet of the 114 of the 54 of the NIA of
said Section 23. EXCEPTING tharef roe the following described parcel.:
The West 330.00 feet of the East 990.00 feet of the West 1320.00 feet of the
Sss of the S4 of the Elk of Section 23, Township 2 North, Range 67 West of the
• 6th P.M., being more particularly described as:
BEGINNING at the West quarter corner of said Section 23; thence 589'34'40"E on an
assumed bearing along the East-West centerline of said Section 23 a distance of
330.00 feet to the TRUE POINT OP BEGINNING;
thence continuing 589'34'40"E a distance of 330.00 feet; thence N00'1S'00"E
parallel with the West line of the NWI of Section 23 a distance of 659.05 feet
to the North line of said Sy of the S4 of the 11114 of Section 23; thence
1189'33'38"W along said North line a distance of 330.00 feet; thence 500'15'00"W
parallel to said West line a distance of 659.15 feet to the TRUE POINT OF
BEGINNING. said parcel being also described as Lot "1" of recorded Exemption
No. 1311-23-2-1E584, recorded April 27. 1983 in Book 994, as Reception.No. 1924869,
County of Weld. State of Colorado
also known L__. ..
TO HAVE AM)TO HOLD the same,together with all and singular the privileges and appurtenances thereunto belonging:In Trust Nevertheless,That in
case of default in the payment of said note or any of them.or any part thereof.or in the payment of the interest thereon,according to the tenor and effect
of said note or any of them,or in the payment of any prior encumbrances,principal or interest,if any.or in case default shall be made in or in case of
violation or breach of any of the terms.conditions,covenants or agreements herein contained,the beneficiary hereunderorthe legal holder of the indebtedness secured
hereby may declare a violation of any of the covenants herein contained and elect to advertise said property for sale and demand such sale,then,upon filing notice of
such election and demand for sale with the saidpartyofthe second part,who shall upon receipt ofsuch notice of election and demand forsale cause a copy of the same to
be recorded in the recorder's office of the county in which said real estate is situated, it shall and may be lawful for said party of the second part to
sell and dispose of the same (en masse or in separate parcels, as the said Public Trustee may think best), and all the right, title and interest
of said part ies of the first part, their heirs or assigns therein,at public auction at the MAIN from door of the Court House.in the County of
WELState of Colorado,or on said premises,or any part thereof as may be specified in the notice of said sale,for the highest and best
price the same will bring in cash, four weeks' public notice having been previously given of the time and place of such sale, by advertisement,
weekly,in some newspaper of general circulation at that time published in said county of` WELD ,a copy of which notice shall be mailed
within ten days from the date of the first publication thereof to the.said part ies of the first part at the address herein given and to such person or
persons appearing to have acquired a subsequent record interest in said real estate at the address given in the recorded instrument;where only the county and state is
given as the address then such notice shall be mailed to the county seat,and to make and give to the purchaserorpurchasers of such property at such sale,acertfcate or
certificates in writing describing such property purchased,and the sum or sums paid therefor,and the time when the purchaser or purchasers(orother person entitled
thereto)shall be entitled to adeed ordeeds therefor,unless the same shall be redeemed as is provided bylaw;and said Public Trustee shall.upon demand by the person or
persons hording the said certificate or certificates of purchase,when said demand is made,or upon demand by the person entitled to a deed to and for the property
purchased. at the time such demand is made, the time for redemption having expired, make and execute to such person or persons a deed or
deeds to the said property purchased, which said deed or deeds shall be in the ordinary form of a conveyance, and shall be signed, acknowledged
and delivered by the said Public Trustee, as grantor. and shall convey and quitclaim to such person or persons entitled to such deed, as grantee,
the said property purchased as aforesaid and all the right, title, interest, benefit and equity of redemption of the part ies of the first
part, their heirs and assigns therein,and shall recite the sum or sums for which the said property was sold and shall refer to the power of sale
therein contained,and to the sale or sales made by virtue thereof;and in case of an assignment of such certificate or certificates of purchase,or in case of the
redemption of such property,by a subsequent encumbrancer,such assignment or redemption shall also be referred to in such deed or deeds;but the notice of sale
need not be set out in such deed or deeds and the said Public T sstee shall,out of the proceeds or avails of such sale,after first paying and retaining all fees.
charges and costs of making said sale,pay to the beneficiary hereunder or the legal holder of said note the principal and interest due on said
note according to the tenor and effect thereof,and all moneys advanced by such beneficiary or legal holder of said note for insurance.
taxes and assessments, with interest thereon at 21.00 per cent per annum, rendering the overplus, if any, unto the said part ies of the first
part. their legal representatives or assigns;which sale or sales and said deed or deeds so made shall be a perpetual bar,both in law and equity,against the
said part ies of the first part, their heirs and assigns.and all otherpersons claiming the said property orany part thereof,by,
from,through or under said part ies of the first part,orany of them.The holder or holders of said note or notes may purchase said property or any pan
thereof;and it shall not be obligatory upon the purchaser or purchasers at any such sale to see to the application of the purchase money. If a release deed be
required,it is agreed that the part ies of the first part, their heirs or assigns,will
ig pay the expense thereof.
No.341A.Rev.12.79. DEED OF TRUST—Public'Duetto—twlm due on sale clause)—Receiver's Clause—Attorney's Fees &83
Bradford Publishing.5825 W.6th Ave.,Lakewood,CO 80214—(303)233.6900
And the said part deS of the first part,for themselves and for their heirs,executors and administrators
covenant and agree to and with the said party of the second part,that at the time of the ensealing of and delivery of these
presents are well seized of the said land and tenements in fee simple,and ha ye good right,full power and lawful
authority to grant, bargain, sell and convey the same in the manner and form as aforesaid; hereby fully and absolutely waiving and releasing
all rights and claims they may have in or to said lands,tenements,and property as a Homestead Exemption,or other exemption,
underand by virtue of any act of the General Assembly of the State ofColorado,or as any exemption underandby virtue of any act of the United States Congress,now
existing or which may hereafter be passed in relation thereto and that the same are free and clear of all liens and encumbrances whatever.
and the above bargained property in the quiet and peaceable possession of the said party of the second part,his successors and assigns,against all and every
person or persons lawfully claiming or to claim the whole or any part thereof,the said part ies of the first part shall and will Warrant and Forever Defend.
Until payment in full of the indebtedness the part ies oft he first part shall timely pay all taxes and assessments levied onthe property any and all amounts
due on account of principal and intereslor other sums on any seniorencumbrances.if any;and will keep all improvements that may be on said lands insured against any
casualty loss,includingextendedcoverage,in a company orcompanies meeting the net worth requirements ofthe beneficiary hereof in anamount not lessthan the then
total indebtedness.Each policy shall contain a loss payableclause naming the beneficiary as mortgagee and shall further provide that the insurance may not he canceled
upon less than ten days written notice to the beneficiary.Atthe option of the beneficiary,the original policy or policies of insurance shallbedelivered to the beneficiary
as further security forth.indebtedness.Should the part des of the first part fail to insure and deliver the policies or to pay taxes orassessmentsasthe same fall
due,or to pay any amounts payable upon senior encumbrances,ifany,the beneficiary may make any such payments or procure any such insurance,and alt monies so
paid with interest thereon at the rate of 21.0 %perannumshall be added to and become a part of the indebtedness seemed by this Deed of Trust and may be paid
out of the proceeds of the sale of the property if not paid by the part 1 eS of the first part.In addition,and at its option,the beneficiary may declare the
indebtedness secured hereby and this Deed ofTfust to be in default for failure to procure insurance or make any of the payments required by this paragraph.
If all or any pan of the property or an interest therein is sold or transferred by First Part without beneficiary's prior written consent,excluding(a)the
creation of a lien or encumbrance adxonlinate to this Deed of Trust,(h)the creation of a purchase money security interest for household appliances.(c)a transfer by
devise,descentorby operation Mlaw upon ihe death ofajoint tenant or(d)the grant of any leasehold interest of three yearsorless nor containing an option to purchase,
beneficiary may.at beneficiary's option,declare all the sums secured by this Deed of Trust to be immediately due and payable.Beneficiary shall have waived such
option to accelerate if.prior to the sateorimnsfer,beneficiary and the person to whom the property is to be sold ortransferred reachagreernent in writing that the credit
of such person is satisfactory to beneficiary and that the interest payable on the sums secured by this Deed of Trust shall be at such rate as beneficiary shall request.
AND THAT IN CASE OF ANY DEFAULT,Whereby the right of foreclosure occurs hereunder,the same party of the second part or the holder of said
note or certificate of purchase,shall at once become entitled to the possession,use and enjoyment of the property aforesaid,and to the rents,issues and
profits thereof, from the accruing of such right and during the pendency of foreclosure proceedings and the period of redemption, if any there be: and such
possession shall at once be delivered to the said party of the second part or the holder of said note or certificate of purchase on request,and on refusal.
the delivery of such possession may be enforced by the said party of the second part or the holder of said note or certificate of purchase by any appropriate
civil suit or proceeding,and the said party of the second part,or the holder of said note or certificate of purchase,or any thereof,shall be entitled to a
Receiver for said property,and of the rents,issues and profits thereof,after such default,including the time covered by foreclosure proceedings and the period of
redemption,if any there be,and shall be entitled thereto as a matter of right without regard to the solvency or insolvency of the parties of the first
part or of the then owner of said property and without regard to the value thereof,and such Receiver may be appointed by any court of competent jurisdiction
upon ex parteapplication and without notice--notice being hereby expressly waived—and all rents,issues and profits,income and revenue therefrom shall be applied
by such Receiver to the payment of the indebtedness hereby secured,according to the law and the orders and directions of the court.
AND,That in case of default in any of said payments of principal or interest,according to the tenor and effect or said promissory note aforesaid,or any
of them,or any part thereof,or of a breach or violation of any of the covenants or agreements herein,by the part ies
of the first part, their executors,administrators or assigns,then and in that case the whole of said principal sum hereby secured,and the interest
thereon to the time of the sale.may at once,at the option of the legal holder thereof.become due and payable,and the said property be sold in the manner and with
the same effect as if said indebtedness had matured, and that if foreclosure be made by the Public Trustee. an attorney's fee of the sum
or a reasonable sum of dollars for services in the supervision of said foreclosure proceedings shall be allowed by
the Public Trustee as a part of the cost of foreclosure,and if foreclosure be made through the courts a reasonable attorney's fee shall be taxed by the court as a part of
the costs of such foreclosure proceedings.
Should any provision ofihis Deedof-Dust be found to violate the statutes or court decisions of the State of Colorado.orofthe UnitedSates.such provision shall be
deemed to be amended to comply with and conform to such statutes and decisions.
INWITNPSSWHEREOF,The said part ies of the first part ha ye hereunto set their hand S and seal
the day and year first above written.
WITNESS: r (SEAL]
. K. Barnett
(SEA LI
•
[SEAL)
. arnett
STATE OF COLORADO, The foregoing ins nt was acknowledged before me this eighth
County of Weld as. dayof Apr. ,1981,by D.K).� Barnett and J. K. Barnett
My commission expires )L/L•r-"y z�, / ',j J'
/
Witness my hand and official seal. �/ /{'/ -•No,uy,$blic
-
FORT LUPTON STATE BANK
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Address P()62:
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AFFIDAVIT OF INTEREST OWNERS
SURFACE ESTATE
Application No. --
Property sec+ �on a3 112N R bind
Subject Prop Y _____-----
STATE OF COLORADO ) ss .
COUNTY OF WELD
THE UNDERSIGNED, being first duly sworn, states that to the best of his or
her knowledge the attached list is a true and accurate list of the names,
addresses and the corresponding Parcel Identification Number assigned by the
•
Weld County Assessor of the owners of property (the surface estate) within
five hundred (500) feet of the property subject to the application. This list
was compiled from the records of the Weld County Assessor, or an ownership
update from a title or abstract company or attorney, derived from such records ,
or from the records of the Weld County Clerk and Recorder. The list compiled
from the records of the Weld County Assessor shall have been assembled within
thirty (30) days of the application submission date.
The foregoing instrument was subscribed and sworn to before me this
1� day 19 by
WITNESS my hand and official seal .
My Commission expires :
rtg_
Notary Public
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CENTRAL. WELD COUN'T'Y WATER DISTRICT
•
December 23, 1982
Mr. Franklin Zadel
217 - let Street
It. Lupton, Colorado 80621
Re: Water Service
Dear Mr. Zadel:
This letter is in response to your request for water service to
described property:
serve the following N
S 990' of V 1,320' of 5k51/2$V1/4 of Section 23.
,
T2 T2 m/1)
167W of the 6th P.M., Weld County, Colorado
ARA:`8 588 Weld Co. Rd. 21; It. Lupton, Co. 80621
Water service can be made available to the above described
property provided all requirements of the District are satisfied.
Central Weld County Water District requires that contracts rbehis
cons mated within one year from the date of this letter, or by
letter shall become null and void unless extended
in the District.
•
Very truly yours. Ovc de0 Lart,io //,:.1/4-/
CENTRAL ER DISTRICT 6k
WELDc0UN1"1WA..T RICT y- I'-� � _ 'Tap
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W C;I••I I:•-•ia••I S MAY , 1904
;,iMIGINAL--AF'F'LI��ANT ; (.�+-11��'Y--l•1l�HC}
HO , G-85006
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM ,ti::i,! I'l""::F;ii:1: 7
l•i�'1 1 .abF� t
WELD COUNTY HEALTH DEP'ARTMEN'T
ENVIRONMENTAL HEALTH SERVICES .
1516 HOSPITAL ROAD, GREELEY, CO 8063i
353-0540 EXT. 270
•
_ ADDRESS 6075 WCR 20 - E IF 3«.. . 0-33-403
tit►I�.I:i.i.�! Z� ..lf,(::I:.{.1-_ CO 80501
OWNER PARi`�ET1 , .. t0�.l:;rt�ON•T
W'Y TEM PENDING CO k3�h:'_1
ADDRESS OF ' PROPOSED I ! L_UE ION _
.. .��C 23 cWr- 2 F'i��G 67
LOT BLOCK 0 FILING 0
LEGAL- DESCRIPTION C11 SITE :
•;UIiD:I;VIM"]:Ott
USE TYPE : RESIDEN"i':i:Ai... �, LOT SIZE i�).c7+ ACRES
'i:it'+i:tt:;i.; PERSONS
BATHROOMS .00
BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY CWCWD IS CONDITIONAL
NAL_ TESTS AND REPORTS AS MAY BE UIRED BY Y THE
APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS O OF THIS APPLICATION
E
UPON FURTHER MANDATORY H AND ADDITIONAL
PURPOSES OF THE EVALUATION OF THEAPi"LIC. ION;
WELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICANT
WELD THE+OllNTY HEALTH DEPARTMENT FOFti
r.�• REGULATIONS ADOPTED UNDER ARTICLE
AND ISSUANCE OF THE PERMIT IS IHURUI_F�T �iND TO ~'UCH TERMS AND CONDITIONS THEPROPOSED
NECESSARY TO INSURE COMPLIANCE WITH
:i cy,SYSTEM
25, CRS i"rO a,
AS AMENDED. THE APPLICANT CERTIFIES THAT SYSTEM. THE
ALL STATEMENTS MADE, INFORMATION AND REPORTS
WIL.1_�EtE ,
:!`;' ;•t'iwfi�i WILL NOT BE LOCATED ...WI WITHIN 400 FEET (]F A COMMUNITY SEWAGE
SUBMITTED
HEREBY ANDTREQUIRED
1=CERTIFIES THAT rF SUBMITTED BY THE APPLICANT ARE,ilDRI l .i ND HEREWITH TRUE U AF DU:I MID C(] D-::
• TO BE AND CORRECT 1'U THE _B��•`"rYOFtF.�i_..fili�q�FA�I'i�ENGE NiDINELIEF ,EVALi.IATsD
INt":
REPRESENTED BE BY THE WELD COUNT
ARE DESIGNED T U RELIED. Ft1i.
.. ._ ; 'MAY RESULT IN THE DENIAL OF THE
- •• �'OSES. OF' ISSUING THE PERMIT APPLIED Ft:'l;, HEf�tL.IN, I FURTHER UNDER—
STAND THE SAME FOR h'UFtI
w-CF��.!•!;► THAT ANY FALSIFICATION OR irilSf�F:FI:C..SI':A1'TC�ilU
N OR REVOCATION l I(:!N OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION A
ND
APPLICATION
IN LEGAL ACTION FOR PERJURY AS PROVIDED BY LA .
JACQUELINE [:+r;I�`:r`!I-,i �
APPLICATION FEE �s i 50 .00 , t3
:i,a,i 1 ..f fti
ti=:t:.' D BY i' ANGE'..., MARYOWi.l:R 'GENT SIGNATURE A
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