HomeMy WebLinkAbout2.0 BOCC Staff Report 03.12.1996• •
BOCC 3/12/96
PROJECT INFORMATION AND STAFF COMMENTS
REQUEST: An exemption from the definition of subdivision.
APPLICANT: Brannan Properties, Inc.
LOCATION- A tract of land located in Section 24, T5S, R91W
of the 6th P.M.; approximately one and one-half
(1.5) miles northwest of New Castle off of CR 245
and CR 241.
SITE DATA: 104 Acres
WATER: Individual wells
SEWER- Individual sewage disposal systems
ACCESS: CR 245 & CR 241
EXISTING ZONING: A/R/RD
ADJACENT ZONING- A/R/RD
I_ RELATIONSHIP TO THE COMPREHENSIVE PLAN
The subject property is located in District A - New Castle Urban Area of Influence and
District F - River/Floodplain Severe Environmental Constraints as designated by the
Garfield County Comprehensive Plan's Management Districts Map.
II. DESCRIPTION OF TI -IE PROPOSAL
A.
Site Description: This 104 acre parcel is located approximately one and one-half
(1.5) miles northwest of New Castle at the intersection of County Roads 245 and
241. East Elk Creek and County Road 241 run through the property in a
north/south direction. Slopes on the tract vary from fairly flat areas near the
creek bottom at the road intersection to slopes well m excess of 40% for a large
portion of the property. Vegetation on the tract appears to be primarily annual
grasses with the neighboring slopes dominated by pinion and juniper. The
proposed 25.58 acre parcel has an existing house with five (5) cabins on it. See
vicinity map, page' 4- .
B. Proposal: The applicant intends to subdivide, by exemption, four (4) lots of
approximately 8.50, 25.58, 35.03 and 35.09 acres each. (See sketch plan, page
- r- )
• •
III_ MAJOR ISSUES AND CONCERNS
A. Subdivision Regulations; Section 8:52 of the Garfield County Subdivision
Regulations states that "No more than a total of four (4) lots, parcels, interests
or dwelling units will be created from any parcel, as that parcel was described in
the records of the Garfield County Clerk and Recorder's Office on January 1,
J97.3, and is not a part ofa recorded subdivision; however, any parcel to be
divided by exemption that is split by a public right-of-way (State or Federal
highway, County road or railroad) or natural feature, preventing joint use ofthe
proposed tracts, and the division occurs along the public right -of way or natural
feature, such parcels thereby created may, in the discretion of the Board, not be
considered to have been created by exemption with regard to the four (4) lot,
parcel, interest or dwelling unit limitation otherwise applicable;"
A deed submitted with the application to demonstrates that the property existed
prior to January 1973. A deed included in the file, shows the existing parcel was
recorded in the records of the Clerk and Recorder in Book 422 at Page 581 in
1971. No previous exemptions have been granted by the Board, therefore, in the
discretion of the Board, it appears this request meets the provisions of Section
8:52 of the Subdivision Regulations and up to four (4) lots may be created by
exemption.
B. Zoni ng The subject property is within the A/R/RD zone district, which requires
a minimum of two (2) acres for each lot. All proposed lots are in excess of this
minimum requirement.
C. Water Supply: The application includes a copy of an existing domestic well
permit for the mother parcel. (See permit pgi+j'3 As a domestic well, it can
be shared by up to three dwellings. There is no documentation regarding the
quantity of water produced from this well. The Board has required applications
to include copies of approved well permits and to provide documentation
regarding the well production prior to any final approval. If documentation is
provided at the public meeting demonstrating either the existing wells
production capacity or a statement about the expected well production from an
engineer qualified to make such a statement. If the Board is satisfied that there
is reasonable evidence regarding the quantity of water, a condition of approval
requiring an applicant to drill a well to meeting the following criteria for
demonstrating the quality, quantity and dependability of a well or a shared well
system, prior to any plat being signed:
1) A well be drilled and a 24 hour pump test shall be performed;
2) The applicant supply, to the Planning Department, the well completion
report demonstrating the depth of the well, the characteristics of the
aquifer and the static water level;
3) The results of the 24 hour pump test indicating the pumping rate in
gallons per minute and information showing drawdown and recharge
shall be submitted to the Planning Department;
4) A written opinion of the person conducting the well test that this well
would be adequate to supply water to the number of proposed lots and
be submitted to the Planning Department;
5) An assumption of an average of no less than 3.5 people per dwelling unit,
using 100 gallons of water per person, per day;
D.
• •
6) If the well is to be shared, the provision for individual water storage
tanks of no less than 1000 gallons for each proposed lot (required at time
of building permit application);
7) A discussion of the mechanical components of the shared well system to
include the pump, water supply line, storage tank and other components
(for shared well systems);
8) A legal, well sharing agreement which discusses all easements and costs
associated with the operation and maintenance of the system and who
will be responsible for paying these costs and how assessments will be
made (for shared well systems);
9) The water quality be tested by an approved testing laboratory and meet
State guidelines concerning bacteria and nitrates.
It will also be necessary to have a 20 ft. square easement around the well and a
ten (10) ft. wide maintenance and repair easement for a waterline to each of the
new lots from the well site easement. If a waterline is to cross under Garfield
Creek, it will be necessary to get a floodplain Special Use Permit for the
placement of the line. This should be noted on the plat.
Sewer- The stated method of waste water disposal is the use of individual sewage
disposal systems. According to the Soil Conservation Service, soils constraints
to use of ISDS are considered moderate due to a slow percolation rate.
E. Floodplain: The sketch map submitted with this application does not show it;
however, after checking the designated floodplain of Garfield Creek and the
ii
Colorado River, it appears that portion of all of the proposed arcels exist
within the designated floodplains. See floodplain map, page `% a.. Staff
recommends a plat note to address this issue, which may also be the appropriate
place for the note regarding the need for a permit to place a waterline in the
creek bottom..
F.
Access: The existing house has an existing access off of CR 335. Staff would
suggest that a letter from the Road and Bridge Department verifying an existing
driveway or a driveway permit be obtained for the new parcels, prior to the
approval of a plat.
G. Fire Protection: The Burning Mountains Fire Protection District has not
responded to this request, indicating this property is within their service area and
access to the lots to be created exists.
H. Easements- Any required easements for drainage, utilities, access, irrigation
ditches, etc., will be required to be shown on the exemption plat.
I.
School Impact Fees- The applicant will be required to pay school impact fees
of $200, for each lot created by this exemption.
J. Potential Road Impact Fees- If or when the County adopts a road impact fee,
the lots created by this exemption will be subject to paying that fee; paid at time
of building permit application, paid by the building permit applicant. This
provision shall be included as a plat note.
• •
IV. SUGGESTED FINDINGS
1. That proper posting and public notice was provided as required for the meeting
before the Board of County Commissioners.
2. That the meeting before the Board of County Commissioners was extensive and
complete, that all pertinent facts, matters and issues were submitted and that all
interested parties were heard at that meeting.
3. That for the above stated and other reasons, the proposed exemption is in the
best interest of the health, safety, morals, convenience, order, prosperity and
welfare of the citizens of Garfield County.
V. RECOMMENDATION
Staff recommends APPROVAL of the application, pursuant to the following
conditions:
1. That all representations of the applicant, either within the application or stated
at the meeting before the Board of County Commissioners, shall be considered
conditions of approval.
2. A Final Exemption Plat shall be submitted, indicating the legal description of the
property, dimension and area of the proposed lots, access to a public right-of-
way, and any proposed easements for setbacks, drainage, irrigation, access or
utilities.
3. That the applicant shall have 120 days to present a plat to the Commissioners
for signature, from the date of approval of the exemption. The Board may grant
extensions of up to one (1) year from the original date of approval.
4. That the applicant shall submit $200.00, per lot, in School Impact Fees for the
creation of all new exemption parcels.
5. That the following plat notes be included:
"The minimum defensible space distance shall be 30 feet on level terrain, plus
appropriate modification to recognize the increased rate of fire spread at sloped
sites. The methodology described in "Determining Safety Zone Dimensions,
Wildfire Safety Guidelines for Rural Homeowners," (Colorado State Forest
Service) shall be used to determine defensible space requirements for the required
defensible space within building envelopes in areas exceeding five (5) percent
grade."
"Upon adoption of road impact fees by the Board of County Commissioners, the
lots created by this exemption shall be subject to paying the fees, paid at time of
building permit application, paid by the building permit applicant."
"Portions of this property lie within the designated floodplain of Garfield Creek.
If any development is proposed for the area within the designated floodplain, it
will be subject to applicable County, State and Federal review and permitting,
which includes the placement of a waterline in the creek bottom."
• •
6. The applicant drill a well meeting the following criteria for demonstrating the
quality, quantity and dependability of a well or a shared well system, prior to
any plat being signed:
1) A well be drilled and a 24 hour pump test shall be performed;
2) The applicant supply, to the Planning Department, the well completion
report demonstrating the depth of the well, the characteristics of the
aquifer and the static water level;
3) The results of the 24 hour pump test indicating the pumping rate in
gallons per minute and information showing drawdown and recharge
shall be submitted to the Planning Department;
4) A written opinion of the person conducting the well test that this well
would be adequate to supply water to the number of proposed lots and
be submitted to the Planning Department;
5) An assumption of an average of no less than 3.5 people per dwelling unit,
using 100 gallons of water per person, per day;
6) If the well is to be shared, the provision for individual water storage
tanks of no less than 1000 gallons for each proposed lot (required at time
of building permit application);
7) A discussion of the mechanical components of the shared well system to
include the pump, water supply line, storage tank and other components
(for shared well systems);
8) A legal, well sharing agreement which discusses all easements and costs
associated with the operation and maintenance of the system and who
will be responsible for paying these costs and how assessments will be
made (for shared well systems);
9) 'The water quality be tested by an approved testing laboratory and meet
State guidelines concerning bacteria and nitrates.
It will also be necessary to have a 20 ft. square easement around the well and a
ten (10) ft. wide maintenance and repair easement for a waterline to each of the
new lots from the well site easement.
7. The applicant shall receive any necessary driveway permits for each lot created,
or a letter from the County Road and Bridge Department stating that the lots
have legal access presently, prior to signing of an exemption plat.
8. The control of noxious weeds shall be the responsibility of the landowner.
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INK. No ovurso ikus
or Closure's unless
initialed.
• •
COLORADO DIVISION 01= WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
PERMIT APPLICATION FORM
( ) A PEl3MI 1 -I() USE GROUND WA I ER
( ) A PLRMI l 1(1 Cull's; I RUC A WELL_
1-08: ( ) A PERMIT 10 IN.`; I At I_ A PUMP
(x ) 13EPL_ACEMLN I I C11i IVO. 011.55y9
( )OTHER
WATER COURT CASE NO. 41_11tt t__—___.
(1) APPLICANT -'nailing address
NAME Paul. 11. Lindy_11'QII
STREET 2026 245 Road
CITY New CasL-1e 8164?
(Statin (LIP)
TELEPHONE NO ( 503) _9_6)f_21.11LL
(2) LOCATION OF PROPOSED WELL
County
Gardi. eld
SE
lwp.
5s
/a of the mil /o, Section 2.
f1 ny. - ._ .9.1 .. _ w_ , —�l rl----- P.M
IfV.`il IL,W)
(3) WATER USE AND WELL DATA
Proposed maxinuuu pumping rate (gpnt) 50
Average annual amount of ground water IY2
to be appropriated (acre-feet):
Number of acres to he irrigated: l
Proposed total depth (feel):
100
Aquifer ground water is to be obtained from:
Surface A1.luv:i.um
Owner's well designation
Lindstrom house Well
GROUND WATER TO 13E USED FOR:
( 1 IIOUSEI10)_D USE_ ONLY • nu iifiganun (0)
(X 1 DOMESTIC (1) ( ) INDUSTRIAL (5)
( ) LIVESTOCK (2) ( ) IRRIGATION (6)
(X) COMMERC)At. (4) ( ) MUNICIPAL (11)
1 ) 0 HlE11 (9)
DETAIL THE USE ON BACK IN (11)
(4) DRILLER
Name Kuchler Water Wells
Slrce( Apple tree 1Parlc //29_
City New-Caotie_, Colorado 8164.2
2 (zip)
lc1Jr J' , s _
Telephone No. _ ,"� i!-�:._`!_. l ic.. No.
1=01( ()f•1=1CL (JSL ONLY: 00 NOT WIt17E IN TIIIS COI LIMN
t
Iteceipt No. �� �) ----
damn
-✓
li;in Dial.
CONDITIONS OF APPROVAL
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
1. THE EXISTING WELL MUST BE PLUGGED AND
ABANDONED ACCORDING TO THE REVISED AND
AMENDED RULES AND REGULATIONS FOR WATER WELL
AND PUMP INSTALLATION CONTRACTORS.
2. THIS WELL SHALL BE ADMINISTERED IN PRIORIT'
3, THE USE OF THIS WELL IS RESTRICTED TO THE
HISTORIC USE FOR ONE PRINCIPAL RESIDENCE AND
FIVE (5) CABINS.
4) THE FINDINGS PREPARED ON NOVEMBER 30, 1982,
ARE MADE A PART HERETO.
5) THE ISSUANCE OF THIS PERM IT. HE REPLACES
PERMIT N0.L15579.
APPLICATION APPROVED
I'EPRMIT NUMOEI1
DATE ISSUED
D[C 0_1E3 19B?
EXPIRATION D_DEC 0 3 19113
TE ENGINEER)
By(,1L (:12a,zy&..r
• •
(5) THE LOCATION OF THE PROPOSED WELL_ and the area on
which the water will be used must be indicated on the diagram below.
Use the CENT EH SLC -1 ION (1 section, 640 acres) for the well location.
-{- ---- -I- --- --I- -- -I-- --- --I- ---- 1._ ._I.. ..-- -
{------- 1 MILL=, 52110 FEET----�-----Y
NO11111
NOIRTI-1 SECTION LINE
SOISTI I SECTION LINE
--I- .1- - I-
I
-1-
-
-
1 -I—
I lie Salle ul the diagram is 2 inches - 1 mile
Each small square represents 40 acres.
(6) THE WELL MUST BE LOCATED BELOW
by distances from section lines.
LOT
250
0. from
South
(11llt 01 :aids)
sec. line
ft. 6.004 _ _ ._i J 11 w`,t— SCC. lint:
SUBDIVISION
BLOCK FILING
(7) TRACT ON WHICH WELL WILL BE
LOCATED owner:
No. of acres l.lft
::prat
1NIII this be
the only well on this tract? Yf q
(B) PROPOSED CASING PROGRAM
('lain Casing
6 , in from 0 ft to `50 0
�- _in. from
Perforated casing
6 in from
ft to ft
50 ft to
100 ft
in. from ft to ;t
WATE 11 6OIJIVALEN r S r ABLE (Rounded Figures)
An acre -loot cava,, 1 acre of land 1 IOW chap
1 cubic loot p01 iecon.l 11.:15) ... 449 gallons per minute lupi))
A family of 5 will iequira approxunateiy 1 1101 1001 of water per year.
1 acre foot ... 43,560 cubic foot . . . 315,900 gallons.
1,000 yprn Uun)peIJ C011linuOusly lot one clay produces 4.42 acre-feet.
(9) FOR REPLACEMENT WELLS givedistance
and direction from old well and plans for plugging
it:
3 ft. East
Fill old well with dirt
(10) LAND ON WIIICIi GROUND WATER WILL- BE USED:
Owner(s)- rILLL No. of acres:
L.t:gal des,:riplio0
(11) QETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal
system to be ttsod.r)ofnes Li c use for household anci 5 cabins. );xis Ling septic tanks and
leach fifulrl.
(12) Q.Ll.B__WL_lI.f-t-..R)ciL=rS used on this land, including wells. Give: 11:1 lstration 11nc1 Walur Court Case Numbers.
I ypc vi (1011
User) lir (purpose) Description of land on which used
(13) TI -IE APPLICAN-I (S( 'STATE(S) THAT THE INFORMATION SE -I- FORTH HEREON IS
i•TRUE TO T,-IE/PEST O, HIS KNOWLEDGE.
-4- /)l
SIGNATURE OF APPL !CAN. 11S1
Use additional sheets of paper 0 more space is required.
FINDINGS OF T1111 `MATE ENGINEER
1N THE MATTER OF AN APPLICATION 10 REPLACE AN EXISTING DECREED WELL IN GARFIE1_D COUNTY,
COLORADO.
APPLICANT: PAUL H. L I NDSTROM
PERMIT NO: F -
In compliance with the provisions of Section 37-90-137, C.R.S. 1973, Paul H.
Lindstrom, 2026 245 Road, New Castle, Colorado, 81647 (hereinafter "applicant") sub-
mitted an application for a permit to replace an existing well, Permit No. 45579, to
withdraw ground water from a tributary aquifer of the Colorado River System. The
application was received complete by the State Engineer on October 21, 1982. On the
basis of the informaLion submitted by the applicant, the field inspection report from
the Water Commissioner and the records in the State Engineer's office, the State
Engineer makes the following findings:
1. The well is located in the SE 1/4 of the SW 1/4 of Section 24, Township 5
South, Range 91 West of the 6th Principal Meridian, Garfield County, Colorado.
2. The well is located outside the boundaries of a designated ground water
basin.
3. The proposed maximum pumping rate is 50 gallons per minute.
4. The proposed well would divert ground water from sand and gravel deposits
which are hydraulically connected to and can affect the rate or direction of movement
of water in the Colorado River.
5. The Colorado River is overappropriated aL some or all times of the year.
The water supply from said river is insufficient to satisfy all the decreed water
rights.
6. The water diverted from the well is used for domestic purposes in a prin-
cipal residence and five (5) cabins.
7. A permit, No. 45579, was issued on April 22, 1971 for domestic purposes.
The well was completed July 20, 1 971 .
8. The well was adjudicated by the Division 5 Water Court in Case No. W-1144
on November 22, 1972 for domestic and commercial purposes.
9. The subject well is adjudicated for 50 gallons per minute.
10. The well does not qualify under the provisions of CRS 1973, 37-92-602(1)(b)
as an exempt well and therefore must be evaluated under CRS 1973, 37-90-137(2).
In view of the above, the State Engineer has found that there will be no sub-
stantial change from the historic use and the issuance of the requested permit will
not materially -injure vested water rights. Therefore, the permit may be issued subject
to the Following conditions:
• •
PAUL H. . I.1 NOS I ROM
PERMIT NO. 11'579
1. Ihe existing we l 1 must he plugged and abandoned according to the revised and
amended Rules and Regulations for Water Well and Pump Installation Contractors.
2. lhis well shall be administered in priority.
3. I he use 01 this we I I is res I.r i c Led Lo the historic use for one principal
residence and five (5) cabins.
Dated this 3n/., day of `---2c_<<;,(<<,_
1982.
Danielson
Slate Engineer
J
By: l `J Z .%r _ �'. �._ C,
Robert A. Longenbaug ;r
Assistant State Engineer
Ground Water Section
Ap3)11cal1un !Oust
11e completi when:
11�1hcul1lc. 1 ype nr
Inu11 1n III Al.IK
INK. No uvcrsu tkcs
or unless
Initialed.
COLUI(AUO DIVISION (JI- WA IFt_li RE=SOURCE=S .
11 Ill Culltunni;ll 131(111., 1313 Sherrrl;ul St., Deover, Colorado 110203
Olt
PERMIT APPLICATION FORM
( ) A PERMIT TO USE GROUND WATER
(X I A PERMIT TO CONSTRUCT A WE1.1..
( 1 A l'LIIMI1 10 INS IALL_ A I'UMI'
( ) REPLACEMENT 1-0R NO
( )OTHER
WATER COUIU CASE NO.
RECEIVE f'
JUN 071982
WAlflt 1lESOURCEti
II45.1E EIIGINEeri
COio,
(1) APPLICANT - mailing address
NAME _P11111 Lind&irQnL
STREET 2.0.2.6__auntY Rd 21ld
CITY New Castle, Co, 816117
(Statu) (Zell
TELEPHONE NO 981+-211411
(2) LOCATION OF PROPOSED WELL
County Garfield
SW % of the SW 'h, Section 211
'Iwo. 5
S. , Rrrg. 91 - WL
IN•SI
11.WI
6th P.M.
(3) WATER USE AND WELL DATA
Proposed (r18xIrllUln ptunpiny rote (91)111) 15 GPM
Average annual amount o1 ground water
to be appropriated (acre-feet): 1Y2 Acre feet
Number of acres to be irrigated: None
Proposed total depth (feet): Fstimate 100 feet
Aquifer ground water is to be obtained from:
Owner's well designation
GROUND WATER TO BE USED FOR:
(X) HOUSEHOLD USE ONLY - 00 irrigation (0)
( 1 DOMESTIC (1) ( ) INDUSTRIAL (5)
( ) LIVESTOCK (2) ( ) IRRIGATION (G)
( ( COMMERCIAL (4) ( ( MUNICIPAL (S)
( 1 OTHER (Y)
DETAIL TI -IE USE ON BACK IN (11)
(4) DRILLER
Name
Street
City
Licensed
(State)
Telephone No tic. No.
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No r) -/G
Basin Dist.
CONDITIONS OF APPROVAL
This well shall he used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
APPROVED FOR HOUSEHOLD USE ONLY, FOR ON8
(1) SINGLE FAMILY DWELLING AND NOT TO BE
USED FOR IRRIGATION. THE RETURN FLOW FROM
THE USE OF THIS WELL MUST BE RETURNED TO
THE SAME STREAM SYSTEM IN WHICH THE WELL
IS LOCATED.
CO ASSURE -MAT THE RETURN FLOW IS TO 1121
RETURNED TO THE SAME STREAM SYSTEM, AN
INDIVIDUAL WASTE -WATER DISPOSAL SYSTEM.
WHEN USED, Mal RE Ob UHF LION -J YFlP_OBAi
;4YPQ
APPLICATION APPROVED
PERMIT NUMBER 1 2 E, : _ 5 U
DATE ISSUED JUN 2 1982
EXPIRATION DATE) I 2 4 19
n
(6) TI L1. LOCATION of: 1 I II I'I(OPOSEI) WELL ,tnrl Iht: ,u u;1 un
w111011 the Wide(' will 111 111;ed 111,1 Ile iiu1 121lt0(1 (111 111(1 tb;tOr;ui1 1)e10W.
lJse the CLIA t_Il SFU111/F1 (1 suction, 040 ucrus) lot Out well 1(11;11(111.
z
J
Z
0
1-
U
0)
1—
N
w
I
.-4 1 MILE, 52110 FEET -- -
} { -I— -{-
I
NOH111 SECTION LINE
r
I �
—I— 1
SOUTH SECTION LINE
-j- -1-
{ -1- -h ----
The scale of the diagram is 2 inches _ 1 unite
Each small square represents 40 acres.
(6) I -HL WELL MUST BE LOCATED 13EL0l^I
by clisl,tnce% 11,1111 1.ct:n(1 hell::.
200
200
:011 1-0
II. Ir(lll sec. line
(nurul or soucn)
West
ft from sec. line
(east or west)
LOT
l3 LOCK FILING u
SUBDIVISION
(7) TRACT ONWI-Ij(�'j WELL WILL BE
LOCATED Owner: 20Ul ,j ndst,�orn
No. of acres 2 . Will this be
the only well on this tinct? yuy
(8) PROPOSED CASING PROGRAM
Plain Casing
7 in from 0 to 75 ft.
in from 0 to ft
Per fora led casing
2 in. from 75 ft to 100 ft
in from ft to ft.
WATER EOl11VALENIS TABLE (Hounded Figures)
An acre• lout covers 1 acre of land 1 foot deep
1 CLIbie foot per second (cis) ... 445 gallons per minute (gpm)
A family of 5 will require approximately 1 acre -toot o1 water per year.
1 acre -loot ... 43,560 cubic feet ... 325,900 gallons.
1,000 gprn pumped continuously for one day produces 4,42 acre-feet.
(9) FOR REPLACEMENT WELLS givedistance
and direction from old well and plans for plugging
it:
(ID) LAND ON WHICH GROUND WATER WILL BE USED:
Owner(s): No. of acres:
Legal description:
(11) OETAILED DESCRIPTION of the use of yround water: Household use and domestic wells must indicate type of disposal
system to be used.
IIJ HOUSE USE ONLY DISPOSAL SYSTEM WILL MEET COUNTY STANDARDS
(12) OTHER WATER RIGHT used on this land, Including wells. Give Registration and Water Court Case Numbers.
Used for (purpose) Description of land on which used
Type or right
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE (31xST OF HIS KNOWLEDGE.
rite
SIGNATURE OF>rkICANT(SI
Use additional sheets of paper it more space is required.
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