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HomeMy WebLinkAbout1.0 ApplicationAUG -12-2002 03:12P FPOM:9LGGPLANGARCO 9'00843470 1110 Submittal Date: APPLICATION Special Use Permit TO : 9%259044 GARFIELD COUNTY PLANNING DEPARTMENT 101rEighth Street, Suite•344, �o Glenwood Springs, CO 81601 Telephone: 970-945-8212 Facsimile: 970-384-3470 la loa Applicant: t Address of Applicant: Conditional Use Being Requested: P:1/5 RECEIVED SEP 2 5 2002 GARFIELD COUNTY BUILDING & PLANNING Base Fez: $400.00 Uk t tro.rd L0 ( Telephone: Zone District: Size of Property: ` • RS - Application Requirements: These items must be submitted with tltc applitanue 1.) Plans and specifications for the proposed use including the hours of operation, the amount of vehicles accessing the site on a daily, weekly and/or monthly basis, and the sizc of any existing or proposed structures that will be utilized in conjunction with the proposed use. Please submit this information in narrative form and be specific. 2.) If you will be using water or will be treating wastewater in conjunction with the proposed use, please detail the amount of water that would be used and the type of wastewater treatment. If you will be utilizing well water, please attach a copy of the appropriate well permit and any other legal water supply information, including a water allotment contract or an approved water augmentation plan. 3.) A map drawn to scale portraying your property, all structures on the property, and the County or State roadways within one (1) mile of your property. if you are proposing a new or expanded access onto a County or State roadway, submit a driveway or highway access permit. 4.) A vicinity trap, showing slope of your property, for which a U.S.G.S. 1:24,000 scale quadrangle map will suffice. 5.) A copy of the appropriate portion of a Garfield County Assessor's Map showing all public and private landowners adjacent to your property. Include a list of all property owners and their addresses. 6.) Attach a copy of the deed and a legal description of the property. If you are acting as an agent for the property owner, you must attach an acknowledgement from the property owner that you may act in his/her behalf. 7.) You must submit an impact statement consistent with the requirements of:Se fion's5:03, =paragraphsl`ihri3. (on industrial type use applications sections 5.03.07 and 5.03.08 will be necessary to address). The consideration of this proposed Special Use will require at least one (1) public hearing for which public notice must be provided. The Planning Department will mail you information concerning this hearing(s), approximately 45 days prior to the scheduled hearing. You will then he required to notify, by certified return receipt trail, to all owners of record as shown in the Assessor's Office of Tots within 200' of the subject lot and to all owners of mineral interest in the subject property and publish the notice provided by the Planning Department, in a newspaper of general circulation. Both these notices must be mailed/published at Least 30 but not more than 60 days prior to the public hearing. The applicant shall bear the cost of mailing and publication and proof of mailing and publication must be submitted at the time of public hearing. The information contained within this application is complete and correct, to the best of m) knowledge: Applicant: ***Please •UDS e seta of applica Date: 1 (:)�. when sub ug for review. • • Narrative of Plans for Home We were gifted approx. 28 acres of land that already has one single family modular home on it. We plan to place a second modular home on the property with its own separate well, septic system, and utilities. This home will be placed on a foundation. The home will have 3 bedrooms and 2 bathrooms. It is 1,869 sq. ft. We plan to designate this the primary home on the property. The other home, which is less than 1500 sq. ft. will be designated as the secondary home and is already occupied. Since the home we are planning to set up will be our primary residence, the hours of operation cannot be accurately stated. The amount of vehicle access will be limited to no more than 3 vehicles daily. We do plan to use and set up the plan provided to us by the county building office for our septic system, which will consist of a 1,250 -gallon septic tank with an adequate leech field. As for our well we plan to drill at least 76 ft. if not further. The well will be hooked up to a filtration and water conditioning system We have provided a copy of our well permit application. The home will have its own electrical meter that will be set up by the electrical company in our area. We have provided a copy of our electrical permit as well. We also plan to set up an appropriate propane tank on the property to provide gas to the home for energy purposes. Explanation of Plans for Section 5.03 1. As we explained above we plan to drill our own well to provide water to the home, set up the septic system suggested by the county building office, and set up utilities appropriate for our homes energy needs. 2. We are not aware of any improvements needed to access the property but we do plan to pave the driveways on the property. 3. We do plan to install a fence along the adjacent property line. We do intend to include some sort of landscaping to provide privacy to both sides of the property line. We do plan to set up a streetlight outside along the driveway as well for safety purposes. 80'd 7641.01 r- :7; < ▪ •-C-1 n c. rn c.; • •• 1 i•-"") -•=1- oI?, KU; on* an. 446:- car L 7cCV 7cc oodanlm Nn]dWbH: ZP:B0 ZOOZ-60-dU Loma AOLDNA L26L L2 OL6 1 Ot:6T aai zo/evto SEP -10-02 09:67 FRW- 425832 • T-287 P.001/001 F-443 COLORADO STATE ELECTRICAL BOARD ELECTRICAL PERMIT NUMBER: 425832 425832 ORIGINAL PERMIT DATE ISSUED: 9! 51/2002 ERMIT EXPIRES ON: 9/ 912003 JOSEPH WILLEY P.O. BOX 1084 RIFLE, CO 81650 Daytime Phone: 070-625-4131 Power Supplier: PUBLIC SERVICE - RIFLE Owner Name: JOSEPH WILLEY & BRANDY Job Address: 30414 HWY 6 & 24 RIFLE GARFIELD DIRECTIONS TO JOB SITE INSTALLATION DESCRIPTION Modular Service MODULAR HOME Fax: 970-625-9044 INSPECTOR: Owens- For Inspection Call: 970/625-5085 Square Footage: 0 Cost of Eleot. Work: $ 1,950 Fee S 45.00 425832 Paid by: Check # 1789 COLORADO STATE ELECTRICAL BOARD DEPARTMENT OF REGULATORY AGENCIES 1580 ..ogan Street, Sulte 550, Denver, Colorado 80203-1941 Phone: (303) 894-2300 425832 •COLOFADO DIVISION OF WATER REeRCES DEPARTMENT OF NATURAL RESOUR S 1313 SHERMAN ST., RM 818, DENVER, CO 80203 phone - info: (303) 866-3587 main: (303) 866-3581 fax: (303) 866-3589 http://www.water.state.co,us RESIDENTIAL Note: Also use this form to apply for livestock watering Water Well Permit Application Review instructions on reverse side prior to completing form. The form must be completed In black ink. Office Use Only • 1 5 2002 ,�LNart�,,.t S/mE LNGNFER COLO, 1 Form GWS -44 (1/2001) 1. Applicant Information Nems of applicant Joseph & Brandy Willey Meiling address 525 E. 12th St. fle j tab gp1de5-0 7:11770" ) 625-4131 2. Type Of Application (check applicable boxes) Construct new well ❑Use existing well 0 Replace existing we!! ❑ Change or Increase use ❑ Change source (aquifer) 0 Reapplication (expired permit) ❑Other: 3. Refer To (if applicable) 6. Use Of Well (check applicable boxes) See Instructions to determine use(s) for which you may qualify El A. Ordinary household use in one single-family dwelling (no outside use) ❑ B. Ordinary household use in 1 to 3 single-family dwellings: Number of dwellings: ❑ Home garden/lawn irrigation, not to exceed one acre: area irrigated 0 sq. ft. ❑ acre ❑ Domestic animal watering - (non-commercial) ❑ C. Livestock watering (on farm/ranch/range/pasture) 7. Well Data (proposed) Well permit I I Water Court case " Maximum pumping rate 1 Annual amount to be withdrawn 15 gpm l acre-feet Total depth Aquifer feet Designated Basin Detetmrnetwn e Welt name or I 4. Location Of Proposed Well Count Section I Township N or S 1 6 ; 92 ❑[n 6th P.M. arfield 1/4 0t the 1/4 • Renae..........E or W I Principal Meridian Distance of well from section Innes (section lines are tyPiCafly not property lineal Ft. from IS NI ❑ S lab Ft. trcm ❑ E ® W 8 Water Supplier Is this parcel within boundaries of a water service area/ 0 YES 10 NO If yes, provide name of supplier: 9. Type Of Sewage System For replacement wells only - distance end direction from old well to new well feet Welt location address lit appiicablei Options(: GPS well location information in UTM format Required settings for GPS units are as follows: format must be UTM Zone must bel 3 Units must be Meters Datum must be NAD27 (CONUSI Unit must be set to true north Were points averaged? 0 YES ❑ NO Northing Easting direction ® Septic tank / absorptior, (each field 0 Central system: District name: ❑ Vault: Location sewage to be hauled to: O Other (attach copy of engineering design and report) 10. Proposed Well Driller License #(I ptional): LIG 11. Signature Of Applicant(s) Or Authorized Agent The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. 24-4.104 (13)(a). 1 have read the statements herein, know the contents thereof and state that they are true to my knowledge. 5. Parcel On Which Well Will Be Located A.You must check and complete one of the following: 0 Subdivision: Name Lot Block Filing/Unit County exemption (attach copy of county approval & survey): Name/4 Lot 4 Parcel less than 35 acres, not in a subdivision, attach a deed with metes and bounds description recorded prior to June 1, 1972 Mining claim (attach a copy of the deed or survey): Name/# Square 40 acre parcel as described in Item 4 Parcel of 36 or more acres (attach a metes and bounds description or survey) Other (attach metes & bounds description or survey and supporting documents) Sign here (Must be original signature Print name E. title -sem-��. Office Us Only of 4 y r parcel Are you the owner of thus parcel? V U I YES ❑ NO lit no - see instructional D. Will this be the only well un this pereelr CO YES 0 NO lif no - list other wellol • E. sista Percel IDI 10000n8ll: USGS mop name Dmap no. I Surface elev. Receipt area only NJ\A/E... Invoice # 495285 7/15/02 -- 1:58:11 PM Cashier ID: 01 $ 60.00 Check. Purchase- #1742 WC — WR CWCs TOPO— 140 Id" rt MYLAR SBb DIV MD \,, 0 = Y tse M, 1 A - + �yi a 7 1 _ >— 1 y r-� �:,� -I�., -, �,� 1, "7' a .v 1 ;, �JJ 111\'1 ,p 91 e HI II \\ H I 11. 1' C/ ; • 7. .I 4 N.1 r . : 6 u• v., a .� 01� — 99 9 , IIS ` _\14, Ile - ` ^ aSs=Y�? �r . )• I ti II'1 1 - \ .. o+rCH- and `_ —✓ � i 0 a -v 560 n E. O v .� 1,1 r > otio� • \a j T/. 7 • \ • •t n , I 90 !n • n to .• C\] 0) co x .'h ns N a W cn N n 0 -r r) cd O Cd 0 — I c 5 m lII O l0 izr 6n )PE0'' on • O_ b O LLB (6S£ 0 U In O 0 0 nii% off 141941 Fre1 Ire4_,Notx, tv o tow% 0 %affairw k 14 0 0 O M I r7 t0 N Io J /,-"7„)co p p,o2{ •D N 1103 -a eoe • • Addresses of Adjacent Landowners 1. Robert & Elaine Coloroso P.O. Box 33574 Northglenn, CO 80233-0574 2. Verna Mullet 14459 County Rd. 18 1/2 Ft. Lupton, CO 80621 3. Donald & Angela Parkison P.O. Box 790 Glenwood Springs, CO 81602 11111111111111111111111111 1111111 II III 111111111 111 r 608315 08/05/2002 04 29P B1375 P497 M ALSDORF 1 of 2 R 10.00 D 0.00 GARFIELD COUNTY CO QUITCLAIM DEED TIIIS DEED, made this / 7 day of between Verna L. Mullett of the County of Weld of Colorado , grantor, and Joseph O. Willey and Brandy Willey Recorder July, 2002 whose legal address is 349 South 9th Street #6, Rifle, CO 81650 and State of the County of Garfield and State of Colorado , grantee: WITNESS, that the grantor, for and in consideration of the sum of ten dollars and other good and valuable consideration DOLLARS, the receipt and sufficiency of which is hereby acknowledged, has remised, released, sold and QUITCLAIMED, and by these presents does remise, release, sell and QUITCLAIM unto the grantees, their heirs, successors and assigns forever, not in tenancy in common but in joint tenancy, all the right, title, interest, claim and demand which the grantor has in and to the real property, together with improvements, if any, situate, lying and being in the County of Garfield and State of Colorado, described as follows: See Exhibit "A" Attached hereto and Made a Part Hereof also known by street and number as: assessor's schedule or parcel number: TO HAVE AND TO HOLD the same, together with all and singular the appurtenances and privileges thereunto belonging or in anywise thereunto appertaining, and all the estate, right, title, interest and claim whatsoever of the grantor, either in law or equity, to the only proper use, benefit and behoof of the grantees, their heirs and assigns forever. The singular number shall include the plural, the plural the singular, and the use of any gender shall be applicable to all genders. IN WITNESS WHEREOF, the grantor has executed this deed on the date set forth above. Verna L. Mullet STATE OF COLORADO County of Weld The foregoing instrument was acknowledged before me this by Verna L. Mul 7\s„.1..ti 1.0 OF GO, 49_S_9th SL.JI6,Rifle,_.CQ__81650 ss. �qtb day of July, 2002 Witness my hand and official seal. My commission expires: / 1—/ — C) 1) i.)j.11.12-44-1 ti, Notary Public Name and Add,css of Pusun Cleating Newly aeateJ Legal Desanptwn (§5s.35-106 5, C k S ) No. 962. Rev. 4-94. QUITCLAIM DEED (to Joint Tenants) a aq 608313 08/05/2002 0429P 61375 P498 M ALSDORF • 2 of 2 R 10.00 D 0.00 GARFIELD COUNTY CO Exhibit "A" Township 6 South, Range 92 West of the 6`1' P.M. Section 7: A tract in Lots 1 and 2, South of the South right-of-way of the Denver and Rio Grande Western Railroad and North of the following described line: Beginning at a point on the East line of Section 7 whence the Section Corner common to Sections 7, 8, 17 and 18 bears South 00°36'00" East 4,555.27 feet; thence South 69°36'00" West 265.53 feet; thence South 72°22'00" West 792.00 feet; thence North 78°16'00" West 595.00 feet; thence North 84°49'00" West 462.00 feet; thence South 64°08'00" West 363.00 feet; thence South 49°08'06" West 325.00 feet to the West line of Lot 2, Except the West 300.00 feet of even width of Lot 2. • • No. 5007 GARFIELD COUNTY BUILDING, SANITA7I0NaodPIr4NNINGDEPARTMENI' 109 lith Street Suite 303 Glenwood Springs, Colorado 81601 (303) 945-8212 Job Address 30414 Highway 6, Rifle Nature of Work Building Permit Use of Building Storage owner Olen F. Willey Contractor Owner Amount of Permit $ 144.00 Permit: 72.00 Investigation Fee: 72.00 Date January 18, 1994 S. Archuleta Clerk Assessor's Parcel 11 W O N w 0 O V 0 0 v TO IIE F LED OUT BY Ark, ADDRESS SUBDIVISION FILING Y TAX SCHEDULE /I LEGAL (SEC/1'faV/I'CNG)N�' ��� Scc)K fsp�! NAME 0%' !fir [ r !� l CITY A71417�, r,t �[ , 6 PHONE GARFIELD) COUNTY APPLICATION FOR BUILDING PE1UI1:r: please print or type PERMIT NUMBER 6.- 90 7 DA'L'E APPLICANT PLOT PLAN Ailf/4///,/,j74 NOTE: Show easements, property line all other structures, specify north, name. For odd shaped lots, or if space is too small, provide separate plot plan, /1 C)F BUILDINGS NOW ON PARCEL USE OFF' IIt1ILDINGS NOW ON PARCEL / / `[./ ey,-1 sir np f S LOT /1 BLOCK 1f NAME ADDRESS NAME CITY ADDRESS :;i TV °HONE LICENSE // CLASS OF WORK 'JEW ALTERATION ADDIT'10N(--"�"'`� DEMOLISH MOVE MOBILE HOME, (make/model) S.F. OF BUILDING p2 V-0 S . F . OF LOT it of FLOORS I( HEIGHT N,• OF FAMILY UNITS N.. OF BEDROOMS i.NTENDED USE OF BUILDING'' .. 51`5r GARAGE: SINGLE DBL CARPORT': SI LE' �' GARAGE:ccc DBE FIREPLACE DOCUMENTS ATTACI1E1) WATER SUPPLY N 0�,c_ DRIVEWAY PERMIT SITE PIAN BUILDING PLANS SANITARY SEWER CLEARANCE ON SITE SEWAGE DISPOSAL PERMIT OTHER DOC M ,NTS (sped y) r2 //r' °i f 7 !r'g R 5/ TA: /N.s'fi-2GTidr sr- //a 7 3 l i9.7. =1 VALUATION 11-W.1.53(Ogf°'of' PERMIT FEE ,$ 72,00 PhAti -eff FEE $ 7Z o O TOTAL FEE $ l f y! e ° SCHOOL IMPACT FEE $ l -- DATE PERMIT ISSUED ZONING DISTRICT FOR OFFICE dimension; and street Ytt Y STltl*1'T NAi1G/ROAD , NUMDER CNECK IF CORNER LOT' DESCRIP:I'.ION OF WORK PLANNED •' + oeux 4,4.1 Car FRONT PROPERTY LINE c i / f4 43y sCr a p Ce•ypt • h°4 I hereby acknowledge that I have read this application and the above is correct and I agree to comply with all county ordinances and state laws regu tang uilding constructi- Sl ,NATURE USE ONLY TYPE OF OCCUPANCY TYPE OF CONSTRUCTION =P7 -ti S.F., OF BUILDING 2 y0 S.F. OF LOT MAX. HEIGHT /2 1- ROAD CLASS. SETBACKS FROM PROPERTY LINE: FRONT' REAR,S�Da 14 RIGHT' IV 200 1-- LEFT' OFF STREET PARKING SPACES REQUIRE " ^ :10;A - APPROVED: IJ( I,D1 N EPARMNT FLOOD !HAZARD CERTIFIED BLDG ELEVATION SPECIAL CONDITIONS f4# ekt QN 4e s a T. m A ,eES1o5 PROBLEMS W :TU PERMIT ater/4 /44` ADDITIONAL INFORMATION NEEDED CERTIFIED BY COLORADO REGISTERED LAND SURVEYOi OR ENGINEER /7-1.1) APPROVED: DATE PLANNING .7I.'t' RTMENT 1177: • • November 10, 1993 Don: I tentatively set up an inspection /investigation of this property for you on Monday the 1 Sth. It is a shed used for storage that was built without a permit. Michael sent them a letter and they came in and filled out the permit. Mr. Bernie Willey is going to contact his father in California to discuss this with him. They may be interested in calling this an agricultural building. However, Mark said that he did not think that this property was being used for an agricultural use. When you look at the building, would you please look at the use of the property and give me an opinion on whether or not it is agricultural. I asked Mr. Willey to make out a check for the $144.00 fees on the permit. He may or may not have this depending on what his father has to say about it. Thanks, -(-41?>bet 79'/A-• /fr,t)//-V, t4- // -/S -- 9 - 3 D /Jij H 4 P , 1g X 2 a — x (oc., A.t6ev-cof er-vec )l hr ��-1-&.-2#" er► �j -- .�i�:►r'�e �dy, .J1Le Ire/Cd FrtgLAr Ifof A-escA • Narrative in Regards to the Existing Residence This house is a modular home with the axles and wheels still in place underneath and skirting around the bottom. The house was actually remove from a site near Rifle Falls and transported to the site where is now. Olen and Opal Willey purchased the property in 1967. The home and septic systems have been in original form since the initial installation in 1967. Since building and septic permits were not issued until 1973, there is no documentation regarding the home or septic installation. To my knowledge there have never been any major improvements, additions, or maintenance to the home or septic system. Further more, there are no plans to make any changes to the home. In regards to the water that supplies the home, the original water source was an open well that was dug by hand and water was also hauled to the home from an outside source. Some years later a well was drilled and I have provided a copy of that well permit. I have also provided a copy of the floor plan for this home. In regards to the vehicle traffic on the property, there will be an average of 6 trips on and off the premises a day. Joseph Willey / Brandy Willey UZ-5' Property Owners RECEIVED GARFIELD COUNTY SING & PLANNING b!l fit, (cies-�1�/. WRJ•5•Rev. 76 •LORADO DIVISION OF WATER RE•RCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 Application must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed. FOR (1) APPLICANT • mailing address PERMIT APPLICATION FORM ,A PERMIT TO USE GROUND WATER ( ) ERMIT TO CONSTRUCT A WELL ( A PERMIT TO INSTALL A PUMP • rt J 123 ( 1 REPLACEMENT FOR NO. ) OTHER WATER COURT CASE NO. NAME cSLY `(\(� STREET - Y -k it ,. , ,7/ Lz - CITY \ .._c' 5's (, `:.,, , q (state) (Z,P) TELEPHONE NO. (7C, '(a 2 • 3 17 j (2) LOCATION OF PROPOSED WELL County Ce)o. EY. of the /V; Y, Section 51:4/1-7711/p. _- R ng. 9 a (N.S) IE,W) i7 P M. (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpm) Average annual amount of ground water to be appropriated (acre-feet): Number of acres to be irrigated: (' i Proposed total depth (feet): ) /On Aquifer ground water is to be obtained from: 47/((.41-", Co /o -a a/ ,4. Owner's well designation GROUND WATER TO BE USED FOR: (--,L) HOUSEHOLD USE ONLY • no irrigation (0) 77P ) ( ) INDUSTRIAL (5) ( 1 LIVESTOCK (2) ( ) IRRIGATION (6) ( 1 COMMERCIAL (4) ( ) MUNICIPAL (8) 1 1 OTHER (91 DETAIL THE USE ON BACK IN (1 1) (4) DRILLER Name (7-71//2 ./' /U/7 C-11/1 -.11 Street City C co 1 (at.) ( PI Telephone No. (rr - S"7 2-/ Lic, No 7 if FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Receipt No / Basin Dist. 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. , l0? 14"7 /00,ee 2(7q 07( Ca 27/ 77- yjr i;'7 5Q,e /4,2/4 /300 0r Eos/ Seg'/•. /.•, /3O7 z ,c) l 9;) 2 y _ 6 eo /307 "-e-7 . Soe.4 PRELImi pi Subjsct to Revision APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE (STATE ENGINEER) BY I D S COUNTY c_ 39 (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 CENTER SECTION (1 section, 640 acres) for the well location. I_NORTH+. (t 1 MILE, 5280 FEET —_yl NORTH SECTION LINE ) SOUTH SECTION LINE The scale of the diagram is 2 inches = 1 mile Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) ... 449 gallons per minute (gpm) A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot ... 43,560 cubic feet ... 325,900 gallons. 1,000 gpm Dumped continuously for one day produces 4.42 acre-feet. (6) THE WELL MUST BE LOCATED BELOW by distances from section lines. `T 6 eOft. from ft from Pc ,'t /V (north or souIt1) .641s7_ (east or west) LOT BLOCK FILING r SUBDIVISION sec. line sec. line. (7) TRACT ON WHICH V LL WILL BE LOCATED * Owne-r` Z �(', '� j5 Will this be No. of acres the only well on this tract? �•�S (8) PROPOSED CASING Plain Casing PROGRAM Fi in from 74 ft. to 7 ft � in from 4/C ft. to g 0 ft. Perforated casing 11/i g in. from ft to l ° ft. in from ft. to `t (9) FOR REPLACEMENT WELLS givedistance and direction from old well and plans for plugging it: (10) LAND ON WHICH GROUND WATER WILL BE USED: Owner(s):l✓ /< �. V77 Legal description: 4 r /�?411Qe '_- / ; . 6,'f /L 71 -No. of acres: 2 S• S (11) OETAILED DESCRIPTION of the use of ground water: Household use and domestic wells system to be used. use s , .d - .rQOS a / Sy / r ^ ? S JL x- ,,Z. must indicate type of disposal / k f e (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Used for (purpose) Type or rght Description of land on which used (13) THE APPLICANT (S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. 2—Y(' — Z(/ SIGNA TURF OF APPL ICANT(SI Use additional sheets of paper if more space is required. i-.-T---f - t + Y._. . •--_--t-_. .. ._� ..-* -- + --'--f----r- ----i' -� -Y -f i --r- ---f" ---4 1 I 7 I r --, 4 + t • T { Aft ii x1 W �o o 0 O~� N a 0 O (D f '-4 4=" El O o = n y o F O o - Z O 10-8EO 10 :31Id .LNSDIIaLV.LS S,NOASAuns NOLIZMOSHG 1[,L27TdO2id N N m alVDS DIHdV230 J 3.1b.fb.00S $I vl 0 t -f CS' y V O 0 u V i. O nom [.) T 1V tt 0 • N. o t -1 (n o o N o c7