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~~ <br />Estimated Water Requirements _ <br />Proposed Water Source(s) <br />Estimated Sewage Disposal Requirement <br />Proposed Means of Sewage Disposal <br />NA gallons/day <br />NA <br />ACTION: <br />Planning Commission Recommendation <br />Approval ( ) <br />Disapproval ( ) <br />Remazks <br />Date <br />Boazd of County Commissioners <br />Approval ( ) <br />Disapproval ( ) <br />Exemption under C.R.S. 30-28-101 (10) (d) <br />Remarks (If exemption, state reason) _ <br />Date <br />( ) <br />Note: This form is required by C.RS. 30-28-136 but is not a part of the regulations of Lake County. <br />_1:!subsumrORMwpd <br />1$ <br />gallons/day <br />Paee 2 of 2 <br />