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Home My WebLink About20210761.tiffCENTRAL WELD COUNTY WATER DISTRICT October 29, 2020 Barton Land & Cattle Inc. 27495 County Road 46 Kersey, CO 80644 RE: Can Serve Dear Mr. & Mrs. Barton, This letter is in response to a request for continued water service to serve the following property described as follows: I'T N2NE4 8 4 64 LOT B REC EXEMPT 1 AMRECX 19-13-0078 Parcel: 105308100056 Water service can continue to the above described property located on County Road 53 between 46 & 48, provided all requirements of Central Weld County Water District, Northern Colorado Water Conservancy District, the Subdistrict, and the U. S. Bureau of Reclamation are satisfied. Central Weld County Water District will require that a Tap Agreement or Tap Assignment be consummated prior to the setting of a tap or this letter shall become null and void unless extended in writing by the District. Please ante that it is pour responsibility to contact Northern Colorado Dater Conservancy District at 800-369-72461o, petitioning confirmation into the Northern Colorado Hater Conservancp_District and Subdistrict Central Weld cannot issue a tap until all requirements are satisfied This is in accordance with the Rules and Refutations' of Northern Colorado Water Conservancy District One water tap may serve a business or a second residence providing that there is only one owner involved and one specific parcel of property. This property is currently being served by Tap 2038, The existing tap has a 300,000 gallon annual water allotment. If the annual water allotment for the tap is exceeded, a CBT surcharge will be assessed on all additional water usage. The CBT surcharge is currently $4.00 per thousand gallons and is scheduled to increase by a dollar on November 1, 2020, A review of the property and what is being served may be required by the District to verify waterlines are not crossing parcels or boundaries. A water tap installation 1s for a specific parcel of property and a customer will not be permitt to extend a service line from one parcel or property to another parcel to provide additional water service. Due to the rapid cost increase of raw water, existing tap fees may not apply for water service to this property. The District will not notify, by separate letter, any prospective landowners or land purchasers of tap fee or line extension cost increases. The cost of a tap fee andlor line extension will have to be paid in advance to the District by the prospective customer in accordance with District policy within one ( I ) year from the date of this letter It is your responsibility to confirm with your local Fire Protection Authority if fire flow water capacity is required for your project. Sincerely, CENTRAL WELD COUNTY WATER DISTRACT SiariLinker, District Manager Slide 2235 2"d Avenue • Greeley, Colorado 80631 • Phone (970) 352-1284 • Fax {970} 353-5865 Stan Linker, District Manager WATER TAP ASSIGNMEW Tap #`203 FOR VALUE RECEIVED, Ilwe hereby sell, transfer and assign to " water p with a 300,000COUNTY WATER DISTRICT, on my/ourproperty d described asfollo s annuasituate inlwater Weld County, C o the to wit: WEED ty, Colorado, to wit, LEGAL DESC; PT N2NE4 8 4 64 LOTS REC EXEMPT RECX13-0078 PARCEL NQ. 105308100054 **There is no tap assigned to Lot A** 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 CO I/we further authorize the Secretary of said District to do any and all things necessary to effectuate this transfer onthebooks and records of said District, Uwe 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 WHEREOF, l/we have set my/our signature this 41 clay o Ifs , 2011. ** SELLER: ** SELLER: lAVE FURTHER AGREE ID pay any and ati charges hereinelier levied by said District for said taps and to abide by all regulations adapted by said District. The District has the right in review the annual allotment and compare it to actual usage to determine it -additional raw water will be purchased and transferred to the District by Tap Holder, *" BUYER. A water tap installation is for a specific parcel of property and in no case will a customer be permitted to extend a service line from one parcel or property to another parcel to provide additional water service. A separate tap will need to be purchased. CONSENT TO ASSIGNMENT I, Stan Linker, District Manager of the CENTRAL, WELD COUNTY WATER ❑iSTRICf, hereby consent to the above assignment on behalf of said District, BY: Stan Linker, District Manager DATE: • _��4 47 PETITION FOR INCLUSION STATE OF COLORADO ) )ss COUNTY OF WELD ) CENTRAL WELD COUNTY WATER DISTRICT TO: THE BOARD OF DIRECTORS OF THE CENTRAL WELD COUNTY WATER DISTRICT llwe, being all of the owners of the below described real property, which property is capable of being served with the facilities of the aforesaid District hereby petition the Board of Directors of said Central Weld County Water District to include the below described real property within the boundaries of said District, Assent to the inclusion of such property is hereby given by the below signers, which signers constitute all of the fee owners of said below described property. (Legal description) Legal Desc: LEGAL PT N2NE4 8 4 64 LOT B REC EXEMPT RECXI3-4078 PARCEL NO. 105308100054 Dated this 4crn day of I'('4�Lt:I�� ,20 lief STATE OF COLORADO COUNTY OF WELD )ss 1 The foregoing Petition was acknowledged before me this 70uC„t+. 20 i(.J1 ,bY Witness my hand and official seal, My commission expires: MAYRA VILLEGAS NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20174002874 My Commission Exputs Jan, 18, 2021 Buyer: 1(1th day of Notary Public Account Number 002038-03 Meter Readings Readings Dates Description Previous Present Usage Read Code Previous Current 1000 Gallons 2157 2236 79 Actual 6/23/2020 7/20/2020 $125.40 ($125.40) Water Minimum Charge Water Usage Charge CBT Surcharge $17.82 $91.81 $0.00 Please write account number on all payments and correspondence. You may pay your bill at www.cwcwd.com Water Consumption 98 84 70 56 42 28 14 6 CENTRAL WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 80631 **INVOICE ENCLOSED** Previous Balance Payment Received Total Current Charges $109.63 Total Due $109.63 Barton Land & Cattle Inc 27495 County Road 46 Kersey, CO 80644 III al ll,I�I��I�I,�I1��1�1 CUSTOMER Barton Land & Cattle Inc SERVICE ADDRESS 22895 County Rd 53 ACCOUNT NUMBER 002038-03 AMOUNT DUE $109,63 BILLING DATE 07/31/20 DUE DATE 08/15/20 ANNUAL ALLOCATION YTD USAGE 300 241 CENTRAL WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 80631 970-352-1284 PRESORTED FIRST CLASS MAIL US POSTAGE PAID GREELEY CO PERMIT NO. 74 Account Number 002038-03 Meter Readings Readings Dates Description Previous Present Usage Read Code Previous Current 1000 Gallons 2236 2307 71 Actual 7/20/2020 8/21/2020 Previous Balance $109.63 Payment Received 0109.63) Water Minimum Charge Water Usage Charge CBT Surcharge $17.82 $85.17 $48.00 Please write account number on all payments and correspondence. You may pay your bill at www.cwcwd,com Water Consumption 98 84 70 56 42 28 14 0 CENTRAL. WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 80631 **INVOICE ENCLOSED** Total Current Charges $150.99 $150.99 Total Due Barton Land & Cattle Inc 27495 County Road 46 Kersey, CO 80644 11II lhIIII 1 I III1„III II�I CUSTOMER Barton Land & Cattle Inc SERVICE ADDRESS 22895 County Rd 53 ACCOUNT NUMBER 002038-03 AMOUNT DUE $150.99 ANNUAL ALLOCATION BILLING DATE 08/31/20 DUE DATE 09/15/20 YTD USAGE 300 312 CENTRAL WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 80631 970-352-1284 PRESORTED FIRST CLASS MAIL US POSTAGE PAID GREELEY CO PERMIT NO. 74 Account Number 002038-03 Meter Readings Readings Dates Description Previous Present Usage Read Code Previous Current 1000 Gallons 2307 2367 60 Actual 8/21/2020 9/21/2020 Water Minimum Charge Water Usage Charge CBT Surcharge $17.82 $76.04 $240.00 Please write account number on all payments and correspondence. You may pay your bill at www.cwcwd,com Water Consumption 98 84 70 56 42 28 14 0 CENTRAL WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 80631 **INVOICE ENCLOSED** Previous Balance Payment Received $150.99 ($150.99) Total Current Charges $333.86 $333.86 Total Due Barton Land & Cattle Inc 27495 County Road 46 Kersey, CO 80644 !Will 1111._111.11l1l„I II CUSTOMER Barton Land & Cattle Inc SERVICE ADDRESS 22895 County Rd 53 hACCOUNT NUMBER 1 002038-03 AMOUNT DUE $333.86 l_ BILLING DATE 1 09/30/20 DUE DATE 10/15/20 ANNUAL ALLOCATSOh YTD USAGE 300 372 CENTRAL WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 80631 970-352-1284 PRESORTED FIRST CLASS MAIL US POSTAGE PAID GREELEY CO PERMIT NO. 74 Scanning Cover Sheet for Septic Permits Permit # Permit Type: SP -9600459 Health / Residential/ New Situs Street Address 25802 CR 48 Situs City, State, Zip SectrownlRange: 08 -04N -64W Applicafion Status: Fineled Application Date: 08/27/1996 Parcel # (12 digits) 105308100052-R3574305 Owner Full Name: NELSON ROY 8 JACQUELINE F Owner Address: 3338 D 112 ROAD ,801520 Contact Name: Contact Address: NELSON ROY 8 JACQUELINE F 3338 D 1/2 ROAD Owner Phone #: S70-434-3486 Contact Phone# 970-434-3486 Information above has been Verified in Awela by em loyee noted below July 17, 2008 Date Report !D: EHS00024v003 Page 1 of 1 Print Date -Time_ 7/17/2008 8:43:53AM WE WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970) 353-0635 EXT 222F FAX (970)356-496Z Permit # Permit Type: Parcel No: Location: Legal Desc: APPLICANT OWNER SP -9600459 Sec/Twn/Rng: 08 04 64 KNEW C -commercial, R4residential + NEW, REPair. VauLT 1053 08 000038 25802 WCR 48 08-04-64 8837 N2NE4 8 4 64 EXC BEG NE COR SEC 25802 WCR 48 NELSON ROY & JACQUELINE F 3338 D 1/•2 ROAD, CLIFTON, CO 801520 NELSON ROY & JACQUELINE F • 3338 D 1/2 ROAD, CLIFTON, CO 801520 Statue: zavalae Applied: 08/27/1996 Issued: 11/22/1996 Finaled: S464.12' S89D Phone: 970-434-3486 Phone: 970-434-3486 Description: POLE Commercial (Y/N): Y Number of Persons: Number of Bedrooms: Water Public (Y/N): N Water Private (Y/N): Y Water Permit No: Percolation Rate: t Ground Slope: 1 Dir: S Soil Suitab Engineer Design Req'd (Y/N): N Minimum Installation• Septic Tank: 1000 gal Actual Installation Septic Tank: /um) gal BARN WITH 2 BEDROOM Residential (Y/N): Y Acres: 70.00 3 Basement Plumbing (Y/N): N 2 Bathrooms-> Full: 1 Utility Name: Cistern (Y/N): 3/4: 1/2: Well(Y/N): Y 7.8 Limiting Zone: >08 ft 00 in Desc: le (Y/N) : Y In 100 Yr Flood Plain (Y/N): Absorption Trench: Absorption Bed: Absorption Trench: Absorption Bed: 330 sq. ft. 430 sq. ft. 419/ 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 14, Title 25, CRS as amended, except for the purpose of establishing final approval of installed aystem for issuance of a local occupancy permit persuant to CRS 1973 25-1U-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 s stem by the Weld County Health Department. �qp ii . oE,ai is i WY? Envi ental Spec .list Date no 4 / V' f WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # - : SP -96O0459 See/Twn/Rng: Permit Type : ' RNEW c -commercial. R.resldential + NEW, RBPair, VauLT Parcel lio : 1053 08 PERMIT Applied: Expires: Location: JCT WCR 48 AND 53 WEST SIDE OF 53 '08-04-64 Legal Desc: APPLICANT OWNER NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON, CO 801520 NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON, CO 801520 Description: Commerci ll (Y/N) : Number of Persons: Number of Bedrooms: Water Public (Y/N): Water Private (Y/N): Water Permit No: Percolation Rate: _% Ground .Slope : POLE BARN WITH 2 BEDROOM F� 3 2 N Y _r Residential (Y/N): Basement Plumbing (Y/N): Bathrooms--> Full: Utility Name: Cistern (Y/N) : 08/27/1996 08/22/1997 Phone: 970-434--3486 Phone: 970-434-3486 Y N 1 Acres: 70.00 3/4: 1/2: Well(Y/N): Y 75/ Limiting Zone: �-ft � in Desc: 1 Dir: � Soil Suitable (Y/N) : T Engineer Design Req'd (Y/N): In 100 Yr Flood Plain (Y/N) : From the application information supplied and the on -situ roil percolation data the following minimum inetallation epecifiaatione are required: Septic Tank: //(1 •� � gallons, Absorption Trench �•)Cli sq. ft. or Absorption Bed C/30 sq. ft. In addition this permit is subject to the follawing additional terms and f/ 1,4"--6.71 (..14-1 f k C �IYcrt (.. Di rI i / = 7J L` CfC(C. / lL}+�•} 'r�i conditions: NOTICE This permit in granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Health Department tar reasons set forth in the Weld county individual•aewage disposal system regulations including failure to meet any term or condition imposed thereon during temporary or final approval. Thu issuance of thin permit does not constitute nssmy)Cion by 4n, dr•,pnrtment or its employees of liability for the failure or inadequacy of the sewage disposal system. This permit is not transferable. Before issuing final approval of this permit 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 is contingent upon the final inspection of the completed system by the Weld County Health Department. `�•41:fCo. 11)6: X En onmental S cialist Date WELD CUuo HE'LL:FR OLP—AIME r SITE EVALUATION r_driOWNER: if � Cr. i APPLICATION NO.: 19 ` � / 5ITEa � � 4 - DATE: ilfi-1 LiNVIRONMLNTAL PROTECTION SERVICES i] .1 SUBDIVISION: PERC0LATI0NTEST DATA: Start Time: � , c.} PT LT BLK gLG Hale Hole H2O O No. De.th. Remain min. V min. min, min. �O min. min. min. min. min. min. 'inc0 •F„ r 1 .7 . &.(,. eto ID 0 - 1 ')- � l .0 del /i r 3 9,01 ... O 4 ."-)j v Cy D() sa_() 560 1 570 (i O . 3 ; 41 , 5 31 7(3 SS° �OU -70 o ?I < - . 3 3 .{: (albrn . F. 6. 0 sTo ' ` v t' v►\ All measurements in .mm unless otherwise indicated. v.- Add H2O, Total t(/ og V Specialist I r intik)A(Ipt- Average Rate ` �g I /Environmental PLAN � SOIL PROFILE �PLOT r _ + 1 I'r i D.4' M loravw,{+1`d Awso.i I 5c . cowlv. Ste. i .. 5-414— tr""bk &. (#.17kmi \s'r-f,d11 . � Le()- ii , li., ? '\ WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # : Permit Type: SP -96O0459 See/TWn/Rag: CNEW c -commercial, R -residential + NEW, REPair, vauLT Parcel No: 1053 08 Location: JCT WCR 48 AND 53 WEST SIDE OF 53 Legal Desc: APPLICANT OWNER NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON, CO 80.520 NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON, CO 8 1520 PERMIT Applied: Expires: 08/27/1996 08/22/199'7 `..,A;) 65.‘P Phone: 970-434-3486 Phone: 970-434-3486 Description: Commercial (Y/N): Number of Persons: Number of Bedrooms: Water Public (Y/N): N Water Private (Y/N): Y _ Water Permit No: Percolation Rate: Ts Ground Slope: -64 Residential (Y/N) : Basement Plumbing (Y/N) : Bathrooms -a Full: Utility Name: Cistern (Y/N): l ig Limiting Zone:?'_a ft _ Dir: .!.3 Soil Suitable (Y/N) : Engineer Design Req'd (Y/N): In 100 Yr Y Acres: 70.00 3/4: 1/2: Well (Y/N) : in Desc: Y ood Plain (Y/N): From the application information Kupplied and the s.o-pits. soil percolation data thm following miuimme installation specifications are required: Septic Tank: gallons, Absorption Trench sq. ft. or Absorption Bed sq. ft. In addition, this permit is subject to the following additional terms and conditions: NOTICE Thie permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the weld County Health Department for reasons set forth in the Weld County individual sewage diapoeal system regulations including failure to meet any term or condition imposed thereon during temporary or final approval. The issuance of this permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage disposal system. This permit is not transferable. Before issuing final approval of this permit the Weld County Health Department reservea the right to impose additional terms and conditions required to meet our regulations on p continuing basis. Final permit approval is contingent upon the final inspection of the completed system by the Weld County Health Department. X Environmental Specialist Date WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # Permit Type: Parcel. No: Location: Legal Desc: APPLICANT ' OWNER SP -9600459 Sec/TWn/Rag: CNF,W C -commercial, R- residential f. NEW, R6pair, YauLT 1053 08 14(9y JCT WCR 48 AND 53 WEST SIDE DF 53 NELSON ROY & JACQUELINE F 3338 D.1/2 ROAD, CLIFTON, CO 801520 NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON; CO 801520 PERMIT Applied: 08/27/1996 Expires: 08/22/'1997 Phone: `970-434-3486 Phone: 970-434-3486 Description: SHOP WITH APT FUTURE HOUSE 8-4-64 Commercial (Y/N): Y Number of Persons: Number of Bedrooms: Water Public (Y/N): N Water Private (Y/N): Y Water Permit No: Percolation Rate: 3 Basement Plumbing (Y/N): 4 Bathrooms-> Full: Utility Name: Cistern (Y/N): `7.8 Limiting % Ground Slope: I Dir: _,ST Soil Engineer Design Req'd (Y/N): Trmn the application information supplied and the on -rite soil are requiredi Residential (Y/N) : Y • 3 Acres: 70.00 3/4: 1/2: Well4Y/N) : Y Zone :>2 ft _ in Desc : Suitable (Y/N): In 100 Yr lood Plain (Y/N): percolation data the following ■iniav•iaetallation Septic Tank: gallons, Absorption or Absorption Bed Trench sq. ft. eq. ft. epeeineatioes In addition, this permit is subject to the following additional terms and Conditions: NOTICE This permit is granted temporarily to allow construction to commence. Thia permit may be revoked or suspended by the Held County Health Department for reasons set,forth in the field County individual sewage dieposal system regulations including failure to meet any term or condition impoeed thereon during temporary or final approval. The issuance of this permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage disposal system. This permit'ia not transferable. Before iasuing final approval of thie permit the Held County Health Department reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval ie contingent upon the final inspection of the completed system by the Weld County Health Department. X Environmental Specialist -Date W1�Yc COLORADO inEmoRAnDum To From SubOct: Whom -it may concern dote 11/22/96 Lyle Moore Jr. Septic Permit #SP -9600459 On November 22, 1996, I received a telephone call from the applicant, of permit SP -9600459, Jacqueline Nelson, of 3338 D I/2 Road, Clifton, CO 81520. In talking with the applicant it was determined that the description for the 'house' was wrong and that the applicant misunderstood what to write down. The description should read pole barn with living quarters inside, not a shop with apartment and future house. The applicants will be living in the pole barn until, 2-3 years, they are able to build a new home at the location. The applicant understands that they will need to obtain a new permit at thi's time. With this new information, I have changed the existing permit, cancelling the requirement for the engineer design. 7/ MELD COUNTY. HEALTH DEPARTME,T ENVIRONMENTAL PROTECTION SERVICES SITE EVALUATION ria OWNER: 1� � . Or\ APPLICATION NO. tSITE: Li s:- 4- DATE:f 11 f)0 SUBDIVI520N: =Fro PERCOLATION TEST DATA: Start Time: Hole No. Hole Depth 0 Remain _. "CM s - .o n Environmental Specialist PLOT PLAN c ff � Ir '44504,1, 4 14 + min. rein G S-3 m n. min. PT, LT S ? T.A_R (/ BLK au======== FLO s 8 . G Total « � Average Rate —7e g SOIL PROFILE (4._ 0,41-sk ti41-171 6'1 N. .(9(1)--V rAtin4 SN1 Ci4" I WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970) 353-0635 MET 2225 FAX (970) 356-4966 Permit # Permit Type: Parcel No: Location: Legal Desc: APPLICANT OWNER SP -9600459 Sec/TWn/Rag: PERMIT RNEW C•commereial. R -residential i NEW. REPair. Vale= Applied: 08/27/1996 1053 08 Expires: 08/22/1997 JCT WCR 48 AND 53 WEST SIDE OF 53 08-04-64 NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON, CO 801520 NELSON ROY & JACQUELINE F 3338 D 1/2 ROAD, CLIFTON, CO 801520 Phone: 970-434-3486 Phone: 970-434-3486 Description: Commercial (Y/N): Number of Persons: Number of Bedrooms: Water Public (Y/N): Water Private (Y/N): Water Permit No: Percolation Rate: 7*y t Ground Slope: / Dire S Engineer Design Req'd (Y/N): A/ POLE N Y 3 2 BARN WITH 2 BEDROOM Residential (Y/N): Y Acres: 70.00 Basement Plumbing (Y/N): N Bathrooms-› Full: 1 3/4: 1/2: Utility Name: Cistern (Y/N) : well (Y/N) : Y Limiting Soil Zane:• -ft — in Desc: Suitable (Y/N) : In 100 Yr Flood Plain (Y/N): prom the application information supplied and the on.site moil percolation data the following minimum inetallation specification are required: Septic Tank: gallons, Absorption Trench 1.Q eq. ft. or Absorption Bed (130 sq. ft. In addition, this permit is subject to the following additional terms and conditions: IC d trf�'si� tr+�+f tA.); ��-L�,��• r G*��t�w� .�,ac�. NOTICE Thie permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Health Department for reasons set forth in the Weld County individual sewage disposal system regulations including failure to meet any term or condition imposed thereon during temporary or final approval. The issuance of this permit does not constitute assumption by the department or ite employee' of liability for the failure or inadequacy of the sewage disposal system. Thie permit is not transferable. Before issuing final approval of this permit 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 is contingent upon the final inspection of the completed system by the weld County Health Department. X EnGi`onmental Sg cialist Date /r-.9,02'4 **************4************************************************************ WELD -COUNTY HEALTH DEPARTMENT (970) 353-0635 RECEIPT ***************+***************t******************************************** Receipt Number -960.02310- -Amount: 115":00-- 11/12/1996 13:01 Payment Method: CHECK Notation: 1004 Init: RBUSTILL Owner Name: Applicant Name: Permit No: Parcel No: Site Address: Location: This Payment NELSON ROY & JACQUELINE F NELSON ROY & JACQUELINE F SP -9600459 1053 08 JCT WCR 48 AND 53 WEST SIDE OF 53 Total Fees: 115.00 Total ALL Pmts: Balance: 265.00 265.00 .00 *************************************************************************** Account Code 256041400-4221.-400 256041400-4221-400 256041400-4221-400 256041400-4221-400 256041400-4730-400 Description New Septic Permit Repair Septic Permit Vault Permit Site Evaluation Potable Water Sample Amount 150.00 .00 . 00 115.00 . 00 Description: SHOP WITH APT FUTURE HOUSE 8-4-64 Commercial (Y/N): Y Number of Persons: Residential (Y/N): Y Acres: 70.00 3 Basement Plumbing (Y/N): Number of Bedrooms: 4 Water Public (Y/N): N Water Private (Y/N): Y Water Permit No: N Bathrooms-> Full: 3 3/4: 1/2: Utility Name: Cistern (Y/N) : Well (Y/N) : Y NOTICE Applicant acknowladgea receipt of the individual sewage disposal system guide and that the completeness of this application is conditional upon further mandatory and additional testa and reports as may be required by the weld County Health Department to be made and furnished by the applicant or by the Held County Health Department for purposes of the evaluation of the application: and the issuance of the permit is subject to such terms and conditions as deemed necessary to inure compliance with rules and regulations adopted under article 10, title 25, CRS as amended. The applicant certifies that the proposed system will not be located within 400 feet of a community sewage system. The undersigned hereby certifies that all statements made, information and reporte submitted herewith and required to be submitted by the applicant are, or will be, represented to be true and correct to the beat of my knowledge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or miarepreeentation may result in the denial o£ the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. *******************4**********************************t**** WELD COUNTY HEALTH DEPARTMENT (970) 353-0635 *********************************************************** Receipt Number: 96001720 - Amount: 150.O0 Payment Method: CHECK Notation: 1192 **************** RECEIPT **************** O8/27/1996 11:46 08/27/96 11:49 Init: VHAMILTO Owner Name: NELSON ROY & JACQUELINE F Applicant Name: NELSON ROY & JACQUELINE F Permit No: SP -9600459 Parcel No: 1053 08 Site Address: Location: JCT WCR 48 AND 53 WEST SIDE OF 53 This Payment 150.00 Total Fees: Total ALL Pmts: Balance: 150.00 150.00 .00 *************************************************************************** Account Code 256041400--4221-400 Description New Septic Permit Amount 150.00 Description: Commercial (Y/N): Number of Persons: Number of Bedrooms: Water Public (Y/N): Water Private (Y/N): Water Permit No: SHOP WITH APT FUTURE HOUSE 8-4-64 Y 3 4 N Y Residential (Y/N): Y Acres: 70.00 Basement Plumbing (Y/N): Bathrooms-> Full: 3 3/4: 1/2: N Utility Name: Cistern (Y/N) : Well (Y/N) : Y NOTICE Applicant acknowledges receipt of the individual sewage diepoeal system guide and that the completeness of this application is conditional upon further mandatory and additional teats and reports as may be required by the weld County Health Department to be made and furnished by the epplicant or by the field county Health Department for purposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10, title 25, CRS ae amended. The applicant certifies that the proposed system will not be located within 400 feet of a community eewage system. The undersigned hereby certifiee that all statements made, information and reports submitted herewith and required to be submitted by the applicant are, or will be, represented to be true and'correct to the beat of my knowledge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. i' , i WELD COUNTY HEALTH DEPARTMENT . 151716Th AVENUE COURT, GREELEY, C.OLORADO 80631 (970) 353-0635 OWNER ADRESS * CITY ST CD ZIP 8/5'10 PHONE - r SITE ADDRESS 9 DIRECTIONS TO SITE Lieu 20 etaa, ii SiA0 VS2 aid �� or) -/h4 cticcf 0E LEGAL DESCRIPTION PT Atela PTA/E * SEC g TWN or/4 RNGLAIS /44 ACRES '`7O SUBDIVISION. LOT BLOCK ` FILING PARCEL CALL ASSESSOR AT 353-3845 EXT 3650 (THIS NUMBER IS DIFFERENT FROM,THE LEGAL DESCRIPTION.) NEW PERC TEST REPAIR .IF REPAIR, PLEASE LIST PREVIOUS OWNERS S150 $115 $125 APPLICANT 1 Bel r ► _ , rr MAILINGADDRESS -633 PHONE RESIDENTIAL _ COMMERCIAL DESCRIPTION (ex. House. M.H (50 X71 a5azalt ad4teni NUMBER OF PERSONS,- 3 BASEMENT PLUMBING KR al/Aims/16)21U &dal 4fogst. -L NUMBER OF BEDROOMS �B BATHROOMS FUIL�L_l 3/4 112 WA'T'ER PUBLIC ('Y/!11}._,;' �]TILIT3' NAME- WATER=PiiiVATEONj.��: '' _:,CISTERNS Yfiy) r .... h-,� LPERIT NO: 4f22117trfre. ?2 th. IAA!! /out -0 ' Ate' GLO.b.t. . Hello