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Home My WebLink About20081618.tiff • • SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL REVIEW (USR) APPLICATION • FOR PLANNING DEPARTMENT USE DATE RECEIVED: RECEIPT#/AMOUNT# /$ CASE#ASSIGNED: APPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number 1467 33 100014 (12 digit number-found on Tax I.D.information,obtainable at the Weld County Assessors Office,or www.co.weld.co.us). Legal Description: Part of the S2 S2 NE4 Section 33 Township 01 North, Range 68 West Flood Plain: No Zone District: A, Total Acreage: 5 Overlay District: No Geological Hazard: No FEE OWNER(S)OF THE PROPERTY: Name: Cambodian Cultural Center Work Phone# Home Phone#(720)890-7290 Email Address: Address: 595 WCR 7 City/State/Zip Code: Erie, CO 80516 Culture Center Contact Information Name: Chantkhan Preap Work Phone#(720)227-4575 Home Phone# Email Address Address: 15661 East 52nd Avenue City/State/Zip Code Denver, CO 80239 • 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: Todd Hodges Design, LLC Work Phone#: (970) 613-8556 Home Telephone#: N/A Email Address: toddhodgesdesign(a gwest.net Address: 1269 North Cleveland Avenue City/State/Zip: Loveland, CO 80537 PROPOSED USE: A Site Specific Development Plan and Use by Special Review Permit for a Cultural Center used for Language and Cultural Education, as well as a center to conduct Religious Ceremonies as a Use Allowed by Special Review in the Agricultural Zone District. 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.da "al /itsil®, EXHIBIT • Signature: Owner or Authorized Agent Da Signature: Owner or Authoriz 2008-1618 • • Chantkhan Preap • 15661 East 52"d Avenue Denver, Colorado 80239 (720) 227-4575 To Whom It May Concern: Please be advised that I, Chantkhan Preap, hereby authorize Todd Hodges Design, LLC, to represent me in my endeavor to obtain a Use by Special Review Permit for property the Cambodian Cultural Center owns, located in part of the south half of the South half of the Northeastern quarter of Section 33, Township 1 North, Range 68 West of the 6th P.M., Weld County, Colorado. VQie / 2 101 Chan an Preap da e • • d�CSKI��d-f8.22 • • ut t3tvos • t 9M6ndiq,cuk-os Letter ofAutliorization To act as an agent To whom this may concern, I/we the president/members of Cambodian Cultural Center authorize Mr. Chantkhan Preap to act as our agent. Mr. Preap will represent us at any step in the future with the proper authorities. Any question regarding our Center,please contact: Chantkhan Preap 15661 E. 52nd Ave. • Denver, Co 80239 (720) 227-4575 I/we authorize him only to represent us when contacting proper authority. If there will be document withdraw I/we must be present Signa For her ' ation,please contact me at(303) 668- 1539. Regards, y Bourn Tho, President 1 0 s7 7C6 Cambodian Cultural Center ate 595 Weld County Road#7 Erie, Co 80516 it Bun Son Khun, Vice President �, OS- / 2/06 6 1 Cambodian Cultural Center ate 595 Weld County Road#7 tr3 Nwpo;,, Erie, Co 80516 a� lu • • OFFICE OF THE SECRETARY OF STATE • OF THE STATE OF COLORADO CERTIFICATE 1, Ginettc Dennis, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, THE CAMBODIAN CULTURAL CENTER is a Nonprofit Corporation formed or registered on 05/31/1984 under the law of Colorado, has complied with all applicable requirements of this office, and is in good standing with this office. This entity has been assigned entity identification number 19871574154 This certificate reflects facts established or disclosed by documents delivered to this office on paper through 04/25/2006 that have been posted, and by documents delivered to this office electronically through 04/28/2006 @ 12:01:23 . I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, authenticated, issued, delivered and communicated this official certificate at Denver, Colorado on 04/28/2006 @ 12:01:23 pursuant to and in accordance with applicable law. This certificate is • assigned Confirmation Number 6478701 . . tCoz n0 � a till t`� gk . Y tit 1 x' Ataritt...._ 1��'�ionvnere ' • l ll YYL .t.1.1.816 ,. Secretary of State of the State of Colorado End of Catalan Nadcq:4 certificate issued electewdcelty ftom the Cabinda Searta t pawn's Web she is falh•a,d imnredlately wand and elfeclft Nanrver, at an option,the Issuance and validity of a certificate obtained electronically may be established by v ti/ the Certificate Conf nnatitm Pagel)! the Secretary of Stales Web site, biro: /nyww,svetslale m.to/bi;/Cc/lificMeSeanhCt'iteriaJQ enter lg the certificate's confirmation number displayed on the certificate. and following the instructions displayed. Confirming the issuance of 6 cefificaic is merely optional and is mg rmessary to the va/id and efectjve/rtnanceyfa certificate For more inhumedptvisit our Web silt. htsp./fwwi.tsus.stale.a,.s,sl dick Business;. Center and select"Frequently Asked Questions " • CERT_ S U Revised 09/22/2005 } Page 1 of 1 • • Michelle Martin • From: Todd Hodges @ Todd Hodges Design, LLC [toddhodges@qwest.net] Sent: Tuesday, September 18, 2007 8:40 AM To: Michelle Martin Cc: Chantkan Preap Subject: PC hearing date request for CCC Michelle: It was great meeting with you on Friday to submitt the Cambodian Cultural Center USR application. I have looked over my calender and discussed the options pertaining to the PC hearing dates with Mr. Preap. Due to a conflict in our schedules concerning the November 20, 2007 hearing, we respectfully request to be placed on the December 18, 2007 PC hearing agenda. Should you need any further information or need to discuss, I can be reached at 970-215-4311. Have a great day! Todd A. Hodges, Principal Todd Hodges Design, LLC 970-613-8556 fax 970-613-8775 • • 09/18/2007 -- Todd Hodges Design, LL C • Use by Special Review Application Prepared for the: Cambodian Cultural Center 595 Weld County Road 7 Erie, Colorado 80516 • Prepared by: Todd Hodges Design, LLC 1269 North Cleveland Avenue Loveland, CO 80537 Submitted: September 14, 2007 • 1269.Vorth Cleveland Avenue • Loveland, Colorado 80537 • (970) 613-8556 • fax: (970)613-8775 email: toddhodgesdesign(a gwest.net net a- . • Todd Hodges Design, LLC • Table of Contents I . Application Form 2. Authorization Form 3. Use by Special Review Development Questionnaire 4. Weld County Road Access Information Form 5. Reduced Use by Special Review Plat, 8- 1/2 x I 1 inch format 6. Soils Map and Associated Narratives 7. FEMA FIRM Community Panel 5. Evidence of Adequate Water Supply 9. Evidence of Adequate Sewage Disposal 10. Surrounding Property Owners List I I . Mineral Affidavit • 12. Certificate of Conveyances including Deed 13. Certificate from Weld County Treasurer indicating no delinquent taxes due for the property 14. a. USR Plat, Attached b. Archway Prototype 15. Application Fee Check in the amount of $3750.00, Attached to Original 16. Use by Special Review Application Submittal Checklist, Attached to Original • 1269 North Cleveland Avenue • Loveland, Colorado 80537 • (970) 673-8556 • fax: (970)613-8775 email: taddhodgesdesign(a tp est.net net • • SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL REVIEW (USR) QUESTIONNAIRE • CAMBODIAN CULTURAL CENTER This application has been prepared by established guidelines found in the Weld County Code,Use by Special Review Application Requirements, and the most current Weld County Procedural Guide for a Use by Special Review Application as found on the Weld County Web Site. 1. Explain, in detail, the proposed use of the property. The proposed use of the site will remain consistent with the Agricultural Zone District and surrounding property uses. The purpose of the Cambodian Cultural Center is to educate members on Cambodian language, culture and religious ceremonies. The religious ceremonies held on site are Buddhist. The existing structures will be utilized. Proposed additions to the site will include: • A traditional gate over the eastern entrance. A prototype is enclosed. • A fenced dumpster area at the eastern entrance. • (2) future pavilion style shelter areas for outside gatherings, one to include men's and women's restroom facitlities. The applicant is requesting approval of the existing uses as well as the proposed uses at this time. Retail sales will not occur from this site. A maximum of 10 individuals will reside on site. Five members currently live at the existing house. A maximum of ten members will live on site including the Monks and Priests for the Cambodian Cultural Center. The home is a three bedroom, three • bathroom house. The additional residents will be part-time members of the Cambodian Cultural Center who want to come and stay for the weekend to study with the Monk, for example. Cultural activities for a maximum of 49 participants will occur 10 — 12 times per year. The site is used for a larger ceremony and celebration once per year. This celebration, Cambodian New Year, attracts approximately 200 people. This celebration occurs in late Winter—early Spring. Participants bring a picnic meal or share pot-luck style. A tent is erected for members to gather and food may also be cooked on outdoor grills. 2. Explain how this proposal is consistent with the intent of the Weld County Code,Chapter 22 (Comprehensive Plan). This Use by Special Review application has been prepared utilizing the process outlined in the Weld County Code and Procedural Guides. The Guiding Principles of the Comprehensive Plan found in Section 22-1-120 states,"Land use changes must afford flexibility based on the specific location and the particular circumstances encountered within this locality. It is also important to weight the cumulative impacts that specific land use changes will have." This proposal is respectful of the surrounding uses. The applicant has pride in their culture and wants to exhibit pride to its members by operating from a clean site. Future construction will be done with attention to detail. The uses proposed will be compatible with the existing and future development of the surrounding area as permitted by the existing zone district and with future development as projected by • Chapter 22 of this Code and any other applicable code provisions or ordinances in effect, or the 1 • • adopted Master Plans of affected municipalities. The operations conducted on site are confined to the enclosed area and building. Most activities occur on contract jobsites. • The property is not located within the I-25 Mixed Use Development area. • • The property is not located within an Intergovernmental Agreement Boundary or standard Urban Growth Boundary area. • The site is within 1 mile of Erie and north of and adjacent to Broomfield. The site is in an urbanizing area. • Surrounding land uses include residential and agricultural uses. Several Use by Special Review and Special Use Permits are located north and east of this site in the surrounding Ranch Eggs Subdivision. These permits allow for Kennels, Landscaping businesses, Home Businesses. A large regional landfill is also within 1 mile of this site. The Comprehensive Plan states, 'The County will cooperate with the applicant in evaluating the objectives of the applicant and the options available to the applicant while ensuring the health, safety and welfare of County residents." The applicant has been working with Weld County Zoning Compliance to remedy the site from violation status. Ms. Salzman has provided guidance to the applicants toward submitting a Use by Special Review permit. Through this application development process, the applicants have carefully considered the health, welfare and safety of the site. The site was sold to the Cambodian Cultural Center as an illegal lot. Recently,this division has been corrected through a Recorded Exemption,RE-4660. This particular site is Lot A of Recorded Exemption RE- 4660. Weld County Code Section 23-3-40 lists the types of uses appropriate as a Use by Special Review in the Agricultural District,"The following buildings, structures and uses may be constructed,occupied, • operated and maintained in the A (Agricultural) Zone District upon approval of a permit in accordance with the requirements and procedures set forth in Article II,Division 4 of this Chapter." Item E lists Public and Quasi-Public Buildings such as Private Schools and Churches are appropriate Uses by Special Review in the Agricultural Zone District. The Cambodian Cultural Center meets these definitions. The "Foundations for Future Land Use (22-2-20.E.3)" specify that growth may occur on lands outside of municipalities which may include land within urban growth boundaries if the impacts of such development are adequately addressed; the infrastructure is capable of handling the intensity of the developments;and the pattern of development is compatible with the region. All three guidelines are addressed as specified in this application. Further, this use has been occurring. The violation is not an outcome of neighbor complaint. The end use will remain compatible with the region. Service is available to the site. The applicants have been working closely with Weld County Planning Services, Weld County Public Health and Mountain View Fire Protection District. 3. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 23 (Zoning) and the zone district in which it is located. This application has been filed in accordance with Article 2,Division 4,Chapter 23 of the Weld County Code, starting with Section 23-2-200. Application materials submitted comply with Article V of • Chapter 23 of the Weld County Code (Overlay Districts). • The property is not located within the I-25 Mixed Use Development area. 2 • • • The property is not located within an Intergovernmental Agreement Boundary or standard Urban Growth Boundary. • • Use by Special Review Design Standards as found in Section 23-2-240 of the Weld County Code were consulted in preparing this application. Section 23-3-110.D indicates that a Church(D.1)and Private Schools(D.3)are uses consistent with the Low-Density (R-1)Residential Zone District. In addition, these same uses are consistent with the Estate(E)Zone District(23-4-430.B and C). The purpose of the Cambodian Cultural Center is to provide members with the opportunity to learn about Cambodian language, culture and religious ceremonies. Surrounding uses include agricultural and rural residential including various special use permits. The site shall be used to carry out these goals. The site has been active and harmonious with surrounding properties since 1987. Adequate provision has been made to protect the health, safety and welfare of the inhabitants of the neighborhood and the County. Operation Standards as found in Section 23-2-260 of the Weld County Code were consulted in preparing this application as stated previously in application materials. Conditions of Approval and Development Standards will ensure the proposed use upholds the purpose and intent of the Weld County Code, Chapter 23 as listed in Section 23-1-40. Such Conditions of Approval and Development Standards as found in the Weld County Code, Referral Agency responses and Staff Comments shall be considered and appropriately incorporated into the final use and site design. The zoning of the site is Agricultural. However, the size of this site is not conducive for farming or ranching activities. The bulk requirements of the Agricultural Zone District found in Section 23-3-50 . shall be adhered to. 4. What type of uses surround the site? Explain how the proposed use is consistent and compatible with surrounding land uses. The site is within 1 mile of Erie and north of and adjacent to Broomfield. The site is in an urbanizing area. Surrounding land uses include residential and agricultural uses. Several Use by Special Review and Special Use Permits are located north and east of this site in the surrounding Ranch Eggs Subdivision. These permits allow for Kennels, Landscaping businesses, Home Businesses. A large regional landfill is also within 1 mile of this site. 5. Describe, in detail, the following: a. How many people will use this site? b. How many employees are proposed to be employed at this site? c. What are the hours of operation? Cultural activities for a maximum of 49 participants will occur 10 — 12 times per year. The site is used for a larger ceremony and celebration once per year. This celebration, Cambodian New Year, attracts approximately 200 persons. This celebration occurs in late Winter — early Spring. Participants bring a picnic meal or share pot-luck style. A tent is erected for members to gather and food may also be cooked on outdoor grills. The future shelter areas will accommodate the outside • gatherings in lieu of the tents. The proposed hours of operation are from 6 a.m. until midnight. 3 • • Five members currently live at the existing house. A maximum of ten members will live on • site. The home is a three bedroom, three bathroom house. d. What type and how many structures will be erected (built) on this site? Two new shelter areas will be constructed in the future. One shelter will connect the current main structure to the existing Monk's prayer temple/shed and is proposed to include a set of restroom facilities. Another shelter will be erected on the south side of the property in the location of the existing smaller shelters. It is the intent of the applicant to work with Mountain Fire Protection District and the Weld County Building Inspection office concerning the options for the proposed shelters. A dumpster enclosure will be constructed at the eastern entrance. A traditional gate will be constructed over the eastern entrance. e. What type and how many animals, if any, will be on this site? None at this time. The site will retain the ability to have animals based on the agricultural zone district. f. What kind (type, size, weight) of vehicles will access this site and how often? Passenger vehicles will access the site during operation. Other equipment may access the site during any applicable construction. g. Who will provide fire protection to the site? The site is within the district boundaries for Mountain View Fire Protection District. • h. What is the water source on the property? Left Hand Water District. Please see attached letter. i. What is the sewage disposal system on the property?A septic system is on site. See letter attached. j. If storage or warehousing is proposed, what type of items will be stored? This is not applicable. The standard shed exists on site for maintenance and gardening equipment. 6. Explain the proposed landscaping for the site. The landscaping shall be separately submitted as a landscape plan map as part of the application submittal. The existing landscaping is illustrated on attached application plat. Additional landscaping is not proposed at this time. 7. Explain any proposed reclamation procedures when termination of the Use by Special Review activity occurs. Appropriate site clean-up from construction operations will be completed. • 4 • • 8. Explain how the storm water drainage will be handled on the site. Historic drainage will not be altered. • 9. Explain how long it will take to construct this site and when construction and landscaping is scheduled to begin. Construction will be completed at the earliest date possible. Any future landscaping will continue to evolve through the years. N, art v, fivreci sf r ,i iy . 10. Explain where storage and/or stockpile of wastes will occur on this site. The Waste Handling Plan for this operation is detailed below for approval by the Weld County Department of Environmental Health Office waste including paper products, lunch containers, etc. will be disposed of in a garbage can/dumpster. The garbage can/dumpster will be located behind the office building and will be screened by an enclosure. Garbage service will be provided by: Waste Management and will be picked up on a regular basis. The internal parking and vehicular circulation areas are paved. Therefore an internal dust abatement plan is not necessary. • • 5 • • ft IAlifee: r I-• t 40, • • � �. k• IP • • • ,. 40. r. t4 . . ...iri r 04. 1040.11Milawamowfr vil • • • ii C' r . I al - • I I f . - I , • 1 r. • . , 1 81l r ...--.00 I 1010F . II billi1/4 , I‘_-,,, .. .4 zt r_-..0.. . 11 1 Hr' r I _• ik- •/yam �.. .Vl-•- _ ~KN fib" •'F* �j^ Y�I''r ".1•.1. _ _ T.C 0 . -4 w • • Report Date: 01/22/2007 10:21AM WELD COUNTY TREASURER Page: 1 STATEMENT OF TAXES DUE SCHEDULE NO: R5839586 ASSESSED TO: • CAMBODIAN CULTURAL CENTER 595 WELD CO RD 7 ERIE, CO 80516 LEGAL DESCRIPTION: 25024-H PT S2S2NE4 33 1 68 BEG 881.32'W OF E4 COR SEC TH WLY ON E-W C/L 326.58' NLY 664.3' TH ELY 329.14' SLY 664.33' TO BEG PARCEL: 146733100014 SITUS ADD: GRAND TOTAL DUE GOOD THROUGH 01/22/2007 0.00 ORIGINAL TAX BILLING FOR 2006 TAX DISTRICT 2390 - Authority Mill Levy Amount Values Actual Assessed WELD COUNTY 16.804* 0.00 EXEMPT PROPE 385,737 111,870 SCHOOL DIST RE1J 38.035 0.00 NCW WATER 1.000 0.00 TOTAL 385,737 111,870 LEFT HAND WATER 0.000 0.00 MTN VIEW FIRE(BOND 2008) 0.160 0.00 WELD LIBRARY 3.261 0.00 BOULDER VALLEY CONSERVATION 0.000 0.00 MOUNTAIN VIEW FIRE 7.817 0.00 TAXES FOR 2006 67.077* 0.00 Credit Levy ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY THE LIENHOLDER OR TO ADVERTISING AND DISTRAINT WARRANT FEES. CHANGES MAY OCCUR AND THE TREASURER'S OFFICE WILL NEED TO BE CONTACTED PRIOR TO REMITTANCE AFTER THE FOLLOWING DATES: PERSONAL PROPERTY AND MOBILE HOMES-AUGUST 1, REAL PROPERTY-AUGUST 1. TAX LIEN SALE REDEMPTION AMOUNTS MUST BE PAID BY CASH OR CASHIERS CHECK. P.O. Box 458 Greeley, CO 80632 .(970)353-3845 ext. 3290 • Report Date: 09/13/2007 10:25AM WELD COUNTY TREASURER Page: 1 STATEMENT OF TAXES DUE SCHEDULE NO: R5839586 ASSESSED TO: • CAMBODIAN CULTURAL CENTER 595 WELD CO RD 7 ERIE, CO 80516 LEGAL DESCRIPTION: 25024-H PT S2S2NE4 33 1 68 BEG 881.32W OF E4 COR SEC TH WLY ON E-W C/L 326.58' NLY 664.3'TH ELY 329.14' SLY 664.33'TO BEG PARCEL: 146733100014 SITUS ADD: - GRAND TOTAL DUE GOOD THROUGH 09/13/2007 0.00 / ORIGINAL TAX BILLING FOR 2006 TAX DISTRICT 2390 - Authority Mill Levy Amount Values Actual Assessed WELD COUNTY 16.804* 0.00 EXEMPT PROPE 385,737 111,870 SCHOOL DIST RE1J 38.035 0.00 NCW WATER 1.000 0.00 TOTAL 385,737 111,870 LEFT HAND WATER 0.000 0.00 MTN VIEW FIRE(BOND 2008) 0.160 0.00 WELD LIBRARY 3.261 0.00 BOULDER VALLEY CONSERVATION 0.000 0.00 MOUNTAIN VIEW FIRE 7.817 0.00 TAXES FOR 2006 67.077* 0.00 * Credit Levy ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY THE LIENHOLDER OR TO ADVERTISING AND DISTRAINT WARRANT FEES. CHANGES MAY OCCUR AND THE TREASURER'S OFFICE WILL NEED TO BE CONTACTED PRIOR TO REMITTANCE AFTER THE FOLLOWING DATES: PERSONAL PROPERTY AND MOBILE HOMES-AUGUST 1, REAL PROPERTY-AUGUST 1. TAX LIEN SALE REDEMPTION AMOUNTS MUST BE PAID BY CASH OR CASHIERS CHECK. P.O. Box 458 Greeley, CO 80632 •(970)353-3845 ext. 3290 WELD COUNTY T ASURER dAtte_ • 7-14-./avere. Pursuant to the Weld County Subdivision Ordinance, the attached Statement(s) .6 of Taxes Due, issued by the Weld County Treasurer, are evidence that, as of this date, all property taxes, special assessments and prior tax liens currently due and payable connected with the parcel(s) identified therein have been paid in full. • Signed � Date g • •ad File r•' ;: Other Case No. APPENDIX B WELD COUNTY ROAD ACCESS INFORMATION SHEET Od County Public Works Department fate 1111 H Street. P.U. Box 758. Greeley.CO 80632 Phone: (970 )356-4000.Ext. 3750 Fax: (970)304-6497 I. Applicant Name Cambccan Culturril Center Phone— Address 595 WCR 7 City Erie State CO z,p 80516 2. Address or location of access 595 WCR 7 Section 33 Township 1N Range 68 Subdivision Block 1.01 - Weld Count/Road :' 7 Side ofRoadfrom East Distance from nearest intersection 3. Is there an existing access to the property' Yes )C No K of accesses 2 4. Proposed Use: Permanent X Residential'Auricultural ] Industrial 3 Temporary D Subdivision D Commercial X Other USR s**. ...*.**4,..as*.**Mc**4*wM*,**.******a*.*******.********.***.*.*t***************dos********************* 5. Site Sketch i' Legend for Access Description: AG = Auricultural 01; RES = Residential • I�t O&G = Oil&Gas l< 5.:', . ' ,.:` D R. - Ditch Road I. ., ,- 94R, -;. _ .. , ' Approximate likTE: See greater detail on i i,'..'..: 7'..94-, NS '' Site Location application map/materials, 't' '•''""� .. M '� �'.. �` - Existing Res V,.--,,: .- • --- Existing Res/Parking OFFICE USE ONLY: Road ADT Date_ Accidents Date Road AM. Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions 0 Installation authorized 0 Information Insufficient FOR COMMERCIAL SITES, PLEASE COMPLETE THE FOLLOWING INFORMATION BUSINESS EMERGENCY INFORMATION: �,,• .' n �, ,� .�/ Business Name:-f_,��j --_�,�,d,�,"1(A,�'c `L441 ___Phone:_ L Z0~ 0 -17 O Address: rJ _City,ST,Zip: err f go 5/k Business Owner: --� Phone: Home Address: — City,ST,Zip: List three persons in the order to be called in the event of an emergency: NAME TITLE ADDRESS PHONE d? u?411c_ CLAI L-liq I\l_ _AE, CZQ Fre Stelt/A-V-ivt- 15-Mot 45 7,4 61 Q. v ±3 OI34 Alta-rS�Thu / ?r16 ice _ , `� 5" Weld d Go Tom! f , Co- 5 --- llar _OLLti AVIV?50C Business Hours: 21 Tk ' _Days: 71 5 Type of Alarm: None Burglar Holdup Fire S'3en Audible Name and address of Alarm Company: Location of Safe: _ r *********************************************************************************************************************************** MISCELLANEOUS INFORMATION: n Number of entry/exit doors in this building: _Location(s): ' '`�' l -4"� Is alcohol stored in building?_ 06_Location(s):____ Are drugs stored In building? 1vb Location(s): Are weapons stored in building?. Location(s): 11AZY:t i'S G. cive, D 'w' LO CA-tog Co 1st. 66Ardawk "Tertfavzeit4 The following programs are offered as a public service of the Weld County Sheriff's Office. Please indicate the programs of interest. Physical Security Check Crime Prevention Presentation UTILITY SHUT OFF LOCATIONS: Main Electrical: Gas Shut Off: — — Exterior Water Shutoff: -^ Interior W ate r Shutoff: • -12- Hello