HomeMy WebLinkAbout20182800.tiffWATER SUPPLY INFORMATION SUMMARY
Section 30.28.133,1d), C.R.S. requires that the applicant submit to the County,'Adequate evidence that a water supply that
is sufficient in terms of quantity, quality and dependability will ha available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
_
,
0 �o _
L Itr & Le
2. LAND USE ACTION i~
3, NAME OF EXISTING PARCEL AS RECORDED
"Ll Q ' 74
SUBDIVISION FILING BLOCK LOT
4, TOTAL ACREAG 3 ii
5. NUMBER OF LOTS PROPOSED PLAT MAP ENCLOSED 0 YES
S. PARCEL HISTORY - Please attach copies of deeds, plats or other evidence or documentation.
A, Was parcel recorded with county prior to Juno 1, 1972? le YES 0 NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? 0 YES 0.,Q.....
If yes, describe the previous action
7. LOCATION OF PARCEL - Include a map delniating the project area and lie to a section corner,
114 OF 1J4 SECTION TOWNSHIP 0 N 0 $ RANGE 0E OW
PRINCIPAL MERIDIAN; 0 6TH 0 h.M. 0 UTE 0 C10STILLA
8. PLAT - Location of all wells on property must be plotted and permit numbers provided. .
Surveyors plat 0 Yes 0 No If not, scaled hand drawn sketch 0 Yes 0 No
9, ESTIMATED WATER REQUIREMENTS - Gabes par Gay or Ace Feet per Yea
HOUSEHOLD USE if of units GPO Al
10. WATER SUPPLY SOURCE
O EXISTING 0 DEVELOPED 0 NEW WELLS
WELLS SPRING i MONISM source-(ciwts ama
WELL PERMIT NUMBERS Gl MOM O VPru ARAPAIRlt
O IIPr t 1IRW$m O LOWnt ARRPAMt
O IOW DAWSON n UMW FOX RIDS
COMMERCIAL USE of S.F. GPO AF
C7 Dew O DMA
IRRIGATION fl of acres GPO :.. AF
0 oreeB
0 MUNICIPAL
STOCK WATERING # of head GPO AF
OTHER .. GPO AF
O ASSOCIATION WATER COURT DECREE CASE NO.'S
0 COMPANY
TOTAL GPO Al
El DISTRICT
NAMEZiff"' Ni
LETTER OF COMMITMENT FOR . -
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES 0 NO IF YES, PLEASE FORWARD WITH THIS FORM. ribs may be requited before our review is completed,)
12. TYPE OF SEWAGE DISPOSAL SYSTEM
li ll SEPTIC TANK/LEACH FIELD 0 CENTRAL SYSTEM • DISTRICT NAME.
O LAGOON 0 VAULT - LOCATION SEWAGE HAULED TO
O ENGINEERED SYSTEM Mttech s copy of enclneerinp desipnl 0 OTHER
SERVICE ADDRESS_
3883 COUNTY ROAD 6
ACCOU ttMRCm
BILL DATE
Make checks payable to o B i kTonc he kR.ICT
Please use standard �
JI111�J1 IIII'lrrlr1'II'111d'llllill
ENRIQUE & ELISA GUEF RERO
13820 HUDSON ST
THORNTON CO 80602--331
Office
Visi
ti your present reading is a 0,
. ur account was estimated
PREVIOUS READING
14-221 -1
03/21/2018
2883.02
$186,43
'IIuIIIIIII1IIIIu11l11IIIII1111 11111f ll111hh11"1111111111'1
LEFT HAND WATER DISTRICT
P.O. BOX 210
NIWOT, CO 80544-0210
Please Detach and Return Top Portion with Your Payment
urs: 8:30 am. - 4:30 p.m., Monday through Friday. Billing Inquiries: (303) 530-4200
vrw_iefthandwater,org for frequently asked questions and important information.
UTILITY BILL;
SERVICE LOCATION
3883 COUNTY ROAD 6
01124/2018
PRESENT READING
PREVIOUS BALANCE
PAYMENTS 01/12/2018
ADJUSTMENTS
WATER BASIC FEE
WATER USAGE
ACTIVATION FEE
SHUTOFF CHARGE
MISCELLANEOUS
Water Usage Rate below. is per thousand gallons.
RESIDENTIAL D 1YSTEm
1st 4,000 $3.50 1st 4.000 $3.50
Next 16,000 $4.68 Next 4.000 $4.6&
Next 30,000 $6.15 Over. 8.000 $13.30
Over 50,000 $7.45
LEFT HAND 1NA
ACCOUNT NUMBER
02/21/2018
2863.02
DAYS THIS BILLING
UNITS USED
Balance Forward
Account Balance
IMPORTANT INFORMATION
COMMERCIAL
$4.50 ALL USAGE
MULTIPLE HOUSING
$4.94 ALL USAGE
TR/CT Mailing Address: P.O. Box 210,N
BILL DATE
02/27/2018
READING ROUTE
'14,000
AMOUNT
10 ' office Address: 6800 Nimbus Road, Longmont,C0
Feb
17
NUMBER OF PEOPLE: 3 BATHROOMS: )
,,. .,m COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL PROTECTION SERVICES
1517 16th Avenue Court
Greeley, Colorado 80631
(303)353-0635
OWNER OF RECORD:
MAILING ADDRESS:
SITE ADDRESS:
%Veld County F feafth Department
SOE 7 4iUk.6-
LOAN 0
ISDS a r 91� -V
REPAIR 0
PERMIT 0
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
// (PLEASE FILL OUT IN BLACK INK ONLY)
PH0NE:O7
3O'5 'CT L
3 3 �C12 Co
fir} C� 863-76
City State Zip
rr- i c- C.- X05 /
City State Zip
LEGAL DESCRIPTION: PT: PT: 56 SECTION: 2-2- TOWNSHIP: 1 RANGE: �, x
SUBDIVISION: LOT: BLOCK: FILING:
LOT SIZE: (70(1C , BEDROOMS:
cIDENTIAL r COMMERCIAL BASEMENT PLUMBING: Yes WATER SUPPLY:
SYSTEM SIZE: Tank is constructed of ( 7 CA e and has
a( ,(1g (material)
FIELD: Bed sq. ft. or Trench sq. ft. DATE SYSTEM INSTALLED:, /h'./ 70
You are required to draw a diagram of the system on the reverse side of this form in
black ink only and indicate location, length, width, and distance from the dwelling.
The undersigned property owner hereby certifies that the above described septic system
is in fact installed, as described, and exists at this time on the parcel of ground
identified by the above legal description and further states that the system is in good
working order and to the best of his/her knowledge is not failing to function properly.
I further understand that any falsification or misrepresentation may result in revocation
of any permit granted based upon this information hereby submitted and in legal action
for perjury as provided by law.
/690 1.7
Date'
Owner
/rah
gallons capacity
SubGcrib' r -and .sworn to before me this ( day of 199 /1
by
Witness my hand and official seal. My commission ex
/94/
Date
STATEMENT OF EXISTING REVIEWED BY:
Environmental Protection Specialist
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