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SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL
REVIEW (USR) APPLICATION
FOR PLANNING DEPARTMENT USE DATE RECEIVED:
RECEIPT # /AMOUNT # /$ CASE It ASSIGNED:
APPLICATION RECEIVED BY PLANNER ASSIGNED:
Parcel Number O 0 b - I (.o - - a (✓ - O _a
(12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, orwww.co.weld.co.us.)
Pt y+-7 4 Ito -Oka -Lou, L-oi- P,
Legal Description Rec. T#cmq& RE. -654L S;41,4 Sectionitr3 Township &o North, Range ldoWest
Flood Plain:
Zone District: , Total Acreage: 441 , Overlay District:
Geological Hazard: , Airport Overlay District:
FEE OWNER(S) OF THE PROPERTY:
Name: m4\\-\r1L.v.J 1\ CIA t�
Work Phone # S10 Sir 1'-4 VI Home Phone # R1O.35tc-96046-Email gr¢mrv3rCA, C (Int.,r.�\
Address: I4 -LS S 1na)i.
Address:
City/State/Zip Code C-7 C 45D1o3\
Name: Kr.a\=.roc. J C,rccn
Work Phone #R10 Tito -169'+ Home Phone # d o ;r+l_ alip6 Email caret" 6r ell G Pen-. corn
Address: 14L65 ►}ui i 35 Z
Address:
City/State/Zip Code C�rccSey C c 413Is3 I,
Name:
Work Phone # Home Phone # Email
Address:
Address:
City/State/Zip Code
APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany applications signed by Authorized Agent)
Name:
Work Phone # Home Phone # Email
Address:
Address:
City/State/Zip Code
PROPOSED USE:
Lars rPc nn.t-\ Dc..C.-.rc. (_t..e A -u iZ i EXHIBIT
I
I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted
with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee
owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee
owners must be included with the application. If a corporation is the fee owner, notarized evidence must be
included indicating that the signatory has to legal authority to sign for the corporation.
Signature: Owner or Authorized' Agent Date Signature: Owner or Authorized Agent Date
2009-2206
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Questionnaire answer sheet
1.Currently I have a Home Daycare Licensed for up to 8 children. I would like to be able to apply for
a Large Family Daycare in witch you can have up to 12 children at our home. Social services require a
form from the county stating that it is ok to have 12 daycare children on our property. We have had
many calls from individuals from the county wanting to bring there kids which is why we are trying to
get a Large family daycare license from the state and a USR from the county.
2.
3.
4. On the west of our property is the K9 bed and breakfast, which is an animal boarding facility. We
share the same entrance off of highway 392. To the east is a private residence that has a horseshoeing
business. North and south of us is all farmland. There are several small businesses around us and most
families need daycare.
5. a. Up to 12 Children and 2 Adults.
b. 1 Employee
c. Hours 7:00 — 5:45
d. Building to be used was built in 2005.
e. 1 pet dog
f. 1 Ford 12 passenger Van (Does not have any advertising on it)
g. Fire is provided by the Eaton Fire Department and Greeley Fire Department
h. North Weld County Water District water only (They are sending us a letter that we have
adequate water for the change)
i. Septic Tank (We had it oversized when we installed it however I already showed everything to a
engineer who will write you a letter approving it for the additional 4 kids)
j. NA
6. No changes. Landscaping is already completed and has been inspected and approved by social
services.
7.There will not be any changes to the property for the Use by Special Review.
8.Not applicable
9. No additional construction will be occurring.
10. We have a 3 yard dumpster that is dumped every Wednesday that is kept by the pole barn.
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