HomeMy WebLinkAbout20021527.tiff erL
DEPARTMENT OF PLANNING SERVICES
1555 N. 17th Avenue, Greeley, CO 80631 l _ n
Phone (970) 353-6100, Ext. 3540, Fax (970)304-6498
USE BY SPECIAL REVIEW APPLICATION c ' ®�
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Application Fee Paid 1 Receipt# 64'111 Date 3115 dL 14
Recording Fee Paid Receipt# Date
Application Reviewed by: 5V
TO BE COMPLETED BY APPLICANT: (Please print or type, except for necessary signature)
Lot A A 2r-d"\
LEGAL DESCRIPTION OF SPECIAL REVIEW PERMIT AREA: W;SE'a of Sec 26,T N,R66W of 6thPM
PARCEL NUMBER: 0_8_0_S 25_4_0as:ta -_(12 digit number-found on Tax I.D.
Information or obtained at the Assessor's Office.
Section 26 , T F N, R 6 6 W-Total Acreage 1 8 0 2 Zone District Overlay Zone
Property Address (if available)1 6 7 51 WCR 64 ( "O" street between W('R 13R,35)
Proposed Use Large Animal Veterinary Clinic
SURFACE FEE (PROPERTY OWNERS) OF AREA PROPOSED FOR THE SPECIAL REVIEW
PERMIT
Name: velar; nary Prnnarti n T. dress:1 qo7 at Avenue
City/State/Zip: creel ey CO Rd-'gig Telephone: Business Telephone 353-81 P5
Name: Address:
City/State/Zip: Home Telephone: Business Telephone
APPLICANT OR AUTHORIZED AGENT(if different than above)
Name:
came ao abovc Kr i � 'pot (Csntact
Address: 'P G. <60X t3`1 1 City/State/Zip: Ei 7S . ilicc.20
Home Telephone: 3 - 3b a 3 Business Telephone:
DEPARTMENT OF PLANNING SERVICES USE ONLY
Case#
Floodplain: 0 Yes 0 No Geologic Hazard: 0 Yes ❑ No
I hereby state that all statements and plans submitted with the application are true and correct to the best
of my knowledge.
Rev: 1-4-01 Sig th : itwin7 or ut 'rized Agent
UV �1 ) v1; EXHIBIT
2002-1527 1
5
USE BY SPECIAL REVIEW QUESTIONNAIRE
1. Explain, in detail, the proposed use of the property.
This property will be used as a large animal veterinary hospital. The mission of
the Countryside Large Animal Veterinary Service, PLLC is to provide a
comprehensive range of preventive, diagnostic, medical and surgical veterinary
services for the owners of large animals in a geographical area within a 40 mile
radius of the hospital. Countryside Large Animal Veterinary Service, PLLC
(formerly Maifeld Veterinary Service) is currently located in east Greeley, and
has been operating in that location for over 25 years. Due to expansion of both
services and clientele, there is a need for a larger and better equipped facility.
The hospital provides services primarily to equine and bovine owners who haul
their animals in for both routine and specialized services. The veterinarians also
make farm calls based on need. Most animals are treated and released the same
day, however, some animals are hospitalized for several days due to the need for
ongoing treatment or observation.
The facility will house areas for examination, treatment and recovery; laboratory;
pharmacy (prescription and retail); and office space. The hospital and adjacent
parking will use approximately 3-4 acres. The remaining acres will be planted in
grass hay which will be used for feeding hospitalized animals.
The land and proposed building is owned by Veterinary Properties LLC. The
owners are the same as for the veterinary practice, Dr. Shawn Bott and Dr. Wade
Shoemaker.
2. Explain how this proposal is consistent with the intent of the Weld County
Code, Chapter 22.
The use is consistent with the Weld County Comprehensive Plan through the
preservation, enhancement and growth of agriculture. Efforts to preserve
productive agricultural land include the maintenance, enhancement and growth of
a viable, profitable agricultural business. The proposed site is not located within a
flood hazard zone, a geological hazard, or airport. The property use is necessary
in Weld County to preserve the agricultural economic base historically
attributable to the area.
3. Explain how this proposal is consistent with the intent of the Weld County
Code, Chapter 23 and the zone district which it is located.
This site is an agriculturally zoned area and is consistent with the intent of the
agricultural zoning and the zone district.
4. What type of uses surround the site? Explain how the proposed use is
consistent and compatible with surrounding land uses.
Adjacent properties are primarily involved in agricultural activities (i.e. farming,
greenhouse, livestock), and a large gravel operation across the road. As several of
the local landowners are current clients of the practice,and the type of business
we conduct caters to a rural clientele we feel that it fits well with surrounding land
uses. Land to the west is a City of Greeley annex that is was zoned industrial to
lure the Budweiser plant 20 years ago. If services can be brought into the area the
zoning may change to residential, however, it is not in the 5 year plan.
5. Describe, in detail, the following:
a. How many people will use this site?
We anticipate a maximum of 25 client visits in the course of a day.
b. How many employees are proposed to be employed at this site?
We currently have 6 employees and we anticipate there will be a total
of 8 employees within 2 years.
c. What are the hours of operation?
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8:00 am to 5:00 pm with emergency after hours as needed.
d. What type and how many structures will be erected (built)on this
site?
One hospital approximately 18,500 square feet. Parking for vehicles
and trailers in the front, as well as a trailer turnaround area in the rear
of the building.
e. What type and how many animals, if any,will be on this site?
There will be no animals permanently housed on the site. Sick
animals may occasionally be kept 1-3 days for treatment and
observation.
f. What kind (type, size, weight)of vehicles will access this site and
how often?
Typical vehicles would include employee vehicles and clients
transporting animals with pickup trucks and stock trailers, or less
frequently by semi-trailer. Occasional shipments(weekly)of supplies
by Federal Express/UPS carriers. Pasture accessed by typical farming
equipment.
g. Who will provide fire protection to the site?
Eaton Fire District
h. What is the water source on the property? (Both domestic and
irrigation).
Water will be provided by the North Weld County Water District for
domestic purposes. The property includes two shares of Capitol stock
in the Nauman Lake Reservoir Co. to be used for irrigation.
i. What is the sewage disposal system on the property?(existing and
proposed).
A new septic disposal system will be designed by an engineer and
constructed using recommendations from the Health Department, such
as; separate waste streams for the hospital and domestic wastes.
j. If storage or warehousing is proposed, what type of items will be
stored?
Hay, medical supplies, pharmaceuticals.
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.
As recommended in a publication by the West Greeley Soil Conservation District,
a windbreak of cotoneaster(cotoneaster acutifolia)bushes will be planted along
the property line on the west side of the building. Plants at maturity will be 6-8 ft.
high and 3-5 ft. wide. Golden current or other ornamental shrubs to be planted in
front of building and surrounded by bark to control weeds. The remainder of
property outside of clinic fence will be planted in grass hay.
7. Explain any proposed reclamation procedures when termination of the Use
by Special Review activity occurs.
Should the facility be permanently discontinued as a veterinary clinic, it would be
marketed under applicable county planning and zoning regulations to its greatest
and best use.
8. Explain how the storm water drainage will be handled on the site.
The proposed hospital will not significantly change the current drainage on the
property. Best management practices will be addressed in the design of parking
and turnaround areas to minimize runoff.
9. Explain how long it will take to construct this site and when construction and
landscaping is scheduled to begin.
Construction is anticipated to begin upon completion of permit and financing
requirements. Construction completion is anticipated within 4-6 months.
Windbreaks and ornamental plantings will be done the following spring.
10. Explain where storage and/or stockpile of wastes will occur on this site.
Excess manure from hospitalized animals will be spread on hay pasture for
fertilizer using best management practices. There will be no long term
stockpiling of manure in order to minimize any fly or odor problems. Deceased
animals are picked up by local by-product companies as needed. Sharps are
sealed in designated containers and picked up with other garbage by BFI.
Outdated drugs are picked up and replaced by drug distributors on a regular basis.
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Mail to: Secretary of State For office use only 031
Corporations Section
1560 Broadway, Suite 200 F unrmirnlu visoN
Denver, CO 80202 COLORADO SECRMARY OFSTATP
(303) 894-2251 2UUii22`-:26
MUST BE TYPED Fax (303) 894-2242 MOO
FILING FEE: $50.00 SECRETARY OF STATE
MUST SUBMIT TWO COPIES 11-23-2001 09:03:55
Please include a typed ARTICLES OF ORGANIZATION •
self-addressed envelope
I/We the undersigned natural person(s) of the age of eighteen years or more, acting as organizer(s)of a limited liability company
under the Colorado Limited Liability Company Act, adopt the following Articles of Organization for such limited liability company:
FIRST: The name of the limited liability company is:Veterinary Properties, LLC
SECOND: Principal place of business(if known): 1907 1st Avenue; Greeley, CO 80631
THIRD: The street address of the initial registered office of the limited liability company is:
1907 1st Avenue; Greeley, CO 80631
The mailing address(if different from above) of the initial registered office of the limited liability company is:
1907 1st Avenue; Greeley, CO 80631
The name of its proposed registered agent in Colorado at that address is:
Wade E. Shoemaker
FOURTH: The management is vested in managers(check if appropriate)
FIFTH: The names and business addresses of the initial manager or managers or if the management is vested in the
members, rather than managers, the names and addresses of the member or members are:
NAME ADDRESS (include zip code)
Wade E. Shoemaker 1907 1st Avenue; Greeley, CO 80631
SIXTH: The name and address of each organizer is:
NAME ADDRESS (include zip code)
Anthony V. Mello 115 N. 2nd Avenue; Ault, CO 80610
Signed Signed
Organi er Organizer
owo7aa 000 Revised 7/95
Form SS-4 Application,or Employer Identificatioi�Jumber
(Rev. April 2000) (For use by employers,corporations,partnerships,trusts,estates,churches, EIN
Department of the Treasurygovernment agencies,certain individuals,and others.See instructions.)
OMB No. 1545-0003
Internal Revenue Service DI.Keep a copy for your records.
^I 1 Name of applicant(legal name)(see instructions) •
_
Veterinary Properties, LLC
2 Trade name of business(if different from name on line 1) 3 Executor,trustee,"care of"name
v
12 4a Mailing address(street address)(room,apt.,or suite no.) 5a Business address(if different from address on lines 4a and 4b)
a 1907 1st Avenue
O 4b City, state,and ZIP code 5b City,state,and ZIP code
b
a Greeley, CO 80631
« 6 County and state where principal business is located
m
w Weld County, CO _—
7 Name of principal officer, general partner, grantor,owner,or trustor-SSN or ITIN may be required(see instructions) ► _
Shawn Bott; SS# 517-76-3541
ea Type of entity(Check only one box.)(see instructions)
Caution:If applicant is a limited liability company,see the instructions for line 8a.
Sole proprietor(SSN) Estate(SSN of decedent)
X Partnership Personal service corp. Plan administrator(SSN)
REMIC National Guard , Other corporation(specify)►
State/local government Farmers'cooperative Trust
Church or church-controlled organization Federal government/military
Other nonprofit organization(specify) ► (enter GEN if applicable)
Other(specify) ►
8b If a corporation, name the state or foreign country State Foreign country
(if applicable)where incorporated
9 Reason for applying(Check only one box.)(see instructions) Banking purpose(specify purpose) ► _—
RI Started new business(specify type)► Changed type of organization (specify new type) ►
real property management Purchased going business
Hired employees(Check the box and see line 12.) Created a trust(specify type) ►•
—_
Created a pension plan(specify type) Other(specify) ► __
10 Date business started or acquired(month,day,year)(see instructions) 11 Closing month of accounting year(see instructions)
01/01/02 Dec.
12 First date wages or annuities were paid or will be paid(month,day,year). Note:If applicant is a withholding agent, enter date income will first
be paid to nonresident alien. (month,day,year) ► n/a
13 Highest number of employees expected in the next 12 months. Note:If the applicant does Nonagricultural Agricultural Household
not expect to have any employees during the period, enter-0-. (see instructions) 0. 0 0 0
14 Principal activity(see instructions) ► real property management
15 Is the principal business activity manufacturing? I I Yes IX No
If"Yes,"principal product and raw material used ►
16 To whom are most of the products or services sold?Please check one box. I I Business(wholesale)
Public(retail) Other(specify) ► X N/A
17a Has the applicant ever applied for an employer identification number for this or any other business? I I Yes X No
Note:If"Yes,"please complete lines 176 and 17c. --
17b If you checked"Yes"on line 17a, give applicant's legal name and trade name shown on prior application,if different from line 1 or 2 above.
Legal name ► Trade name ►
17c Approximate date when and city and state where the application was filed. Enter previous employer identification number if known.
Approximate date when filed(mo.,day,year) City and state where filed Previous EIN
under penalties of perjury,I declare that I have examined this application,and to the best of my knowledge and belief,rt is true,correct,and complete. Business telephone number
(Include area code)
970.353.8185
Fax telephone number(Include area code)
Name and title (Please type or print clearly.) ► IRS Notice 2000-19 970.353. 0749
"signature ► Date► 11/28/01
Note:Do not write below this line. For official use only.
Ind. Class Size Reason for applying
Please ieave Geo
blank ►
For Privacy Act and Paperwork Reduction Act Notice,see page 4. Form SS-4(Rev 4-2_-)r-
SA
ow9012 I 000
VETERINARY PROPERTIES, LLC
CONSENSUAL RESOLUTIONS ADOPTED IN LIEU OF
FORMAL ORGANIZATIONAL MEETING
THE UNDERSIGNED, being the sole Members of Veterinary Properties LLC, a Colorado
Limited Liability Company, hereby adopt the following Resolutions in lieu of the convening of a
formal meeting of the Members to consider and adopt such Resolutions.
FURTHER RESOLVED that the original recorded Articles of Organization endorsed to
show filing with the Colorado Secretary of State's office, he filed in the permanent records of the
Company.
FURTHER RESOLVED that the following named persons are the sole Members in the
Company:
Shawn Bott 1907 1st Avenue
Greeley, CO 80631
Wade Shoemaker 1907 1st Avenue
Greeley, CO 80631
FURTHER RESOLVED that Bank ("Bank"), be and it
hereby is designated as a depository of this Company, and that the hank he and it hereby is
authorized to accept for credit to this Company and/or for collection, any and all checks, drafts,
notes and other negotiable instruments payable to this Company or in which it may have an
interest, when endorsed in the name of this Company, in writing, by rubber stamp, or otherwise,
with or without a designation of the party making such endorsement.
FURTHER RESOLVED that the Company's accounts at Bank shall he designated as
follows: "Veterinary Properties, LLC"
FURTHER RESOLVED that any and all funds standing to the credit of this Company with
the bank in its accounts may be withdrawn upon checks, drafts and orders or other undertakings
for the payment of money, when signed in the name of the Company by Shawn Bott or Wade
Shoemaker.
FURTHER RESOLVED that the above-named Members are is empowered in accordance with the
provisions of the next preceding Resolution also to collect, discount, negotiate, endorse, and assign in the name
of the Company, all checks, drafts, notes and all other paper, which are payable to the Company or in which
the Company has an interest.
FURTHER RESOLVED that the signature of the above-named Members shall he duly certified to
the bank and shall be submitted on the bank's own form of signature cards, and that the hank is hereby
authorized to honor and pay any and all checks, drafts and orders so signed, without inquiry as to the
circumstances of issue or the disposition of the proceeds thereof, whether drawn for individual obligations or
for deposit to the individual accounts of the Members above named, for cash or otherwise.
FURTHER RESOLVED that the above-named Members, he and hereby is authorized for and on
behalf of, and in the name of this Company, to:
(a) negotiate and procure loans from Bank up to an amount not
exceeding $100,000.00 in the aggregate at any one time outstanding;
(b) discount with said bank, commercial or other business paper
belonging to this Company, made or drawn by or upon third parties without limit
as to amount;
(c) give security for any liabilities of this Company to said bank by
pledge or assignment or lien upon any real or personal property, tangible or
intangible, of this Company, and;
(d) execute in such form as may be required by the bank all notes and
other evidences of such loans, all instruments of pledge, assignment or lien,
provided, however, that none of the same shall he valid unless so signed or
endorsed as provided above.
FURTHER RESOLVED that said bank he and it is hereby authorized and directed to pay the
proceeds of any such loans or discounts as directed by the person so authorized to sign, whether payable
to the order of said person in his individual capacity or not, and whether such proceeds are deposited in
the individual credit of such person or not.
FURTHER RESOLVED that all of the aforesaid Resolutions relating to the banking relationship of
the Company and each of them shall remain in force until revoked in writing and such revocation is
delivered to Bank.
FURTHER RESOLVED that the above-named Members he and hereby are authorized to execute
the bank's standard form "Corporate Authorization" so long as such standard form resolutions are
substantially similar to the above and foregoing resolutions.
Effective this 'l th day of 1D(t120( , 200 Z.
V��A�pu.11111111�Ill/Ifgfl,,�� i -- ��}L�_
\. S P F �°�ii Shawn Bott
Laic
CJ �
C';./ p T A R
s Wade Shoemaker
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CAWPD0f5OP�'#,,CLIENTS\C0UNTRYSIDE VET\VET PROPERTIES\RESOLUTTr.(Ij.DOC
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CR 100(03/00)
1375 r Sherman Cot Stree261-0 COLORADO BUSINESS REGISTRATION 19 01
Denver De Str et
PLEASE PRESS FIRMLY AND PRINT CLEARLY-INSTRUCTIONS FOR THIS FORM ARE IN THE PUBLICATION CR 101
1J THE REVERSE SIDE OF THIS PAGE 1. REASON FOR FILING THIS APPLICATION '
MUST BE COMPLETED ®Original Applicaten ❑Change of Ownership
If trade name registration with the Department of
Do you have a Dept of Revenue Account Number? ❑yes El no
C Revenue is required,the information marked with a IF YES,Account#
Zdiamond will become public record. Do you want this number assigned to new location' ❑yes ❑ no
2. INDICATE TYPE OF ORGANIZATION
Individual i ❑ Limited Liability Limited _ Estate ❑ Other Non-Profit
z _ General Partnership _ Partnership(LLLP) _ Government
w Limited Partnership _, Corporation _ Joint Venture ❑ Other
O r Limited Liability Company(LLC) _ '5'Corporation Trust DO NOT WRITE IN THIS SPACE
—
Limited Liability Partnership(LLP) _ Association _ Non-profit 501 (C)(3)
Q — (Please enclose copy of the IRS letter of exemption.) SIDE A
1 Taxpayer Name(owner, partners or corporate name)(last,first,middle)
Veterinary Properties, LLC
2a. Trade Name/Doing Business As(if applicable) 2b.Federal Employer Identification Number(FEIFli
applied for __
3a Street Address of Principal Place of Business in Colorado City State ZIP
X1907 1st Avenue Greeley *CO X80631
3b County If business is within limits of a city,what city? Telephone
weld Greeley (970 )353-8185
4a. In Care Of(c/o) 4b. Mailing Address(if different from above)(include unit Si)
z . —
O City State ZIP Telephone
CC ' . ( ) __
O 5 Bank Name(if available) —Bank Address Bank Account Number
LL
2
2• 6 First Day of Payroll(MO/DAY/YR) Payroll Records Location(list address) Payroll Records Telephone
a n/a ( )
7 What products and/or services do you provide?(complete section"H") Do you sell motor vehicle tires? Li Yes bJ Nn
areal property management Do you rent out items for 30 days or less? n Yes ®No _
O 8a. Owner/Partner/Corp.Officer Title Social Security# Federal Employer Identification Number(FEIN)
re
° Shawn Batt Member 517-76-3541 --
m fib.Address(residence or P.O.Box,street,city,state,ZIP) Telephone
X1907 1st Ave; Greeley, CO 80631 (970 )353-8185 _
9a Owner/Partner/Corp. Officer Title Social Security# Federal Employer Identification Number(FEIN)
♦ —
9b Address(residence or P.O.Box,street,city,state,ZIP) Telephone
♦ ( ) _
If you acquired the business in whole or in part,complete the following:
10a. Prior Taxpayer Name Date of Acquisition Prior Taxpayer UI Tax Account Number "1
10b Address City State ZIP i
1 ❑ If Seasonal,mark 5 JAN ❑APR ❑JULY ❑DCT PERIOD COVERED E.L FEES
each business month. ❑ FFB ❑MAY ❑AUG ❑NOV MO/YR
X ❑ MAR 5 JUN ❑SEPT 5 CEC (0280-Trade Name
H
. t 2b. First Day of Sales(MO/DAY/YR) 750) Registration (ggg)$
0 2a FILING FREQUENCY: If sales tax collected is.
I
m ❑ $15.00/month or less-Annually (0020-State Sates Tax
vac, ❑ Under$300/month-Quarterly REVENUE REGISTRATION ACCOUNT NUMBER 810) Deposit (355) $
❑ $300/month or more-Monthly —
O n Wholesale only-Annually (0080-gales Tax
3 Indicate which applies to you'. 5 Single Event-Period Covered 750) License (999) $
_
❑ Wholesaler 5 Charitable (MO/DAY/YR) (0100-wholesale
5 Retail-Sales 5 Multiple Event 750) License (999)$
5 Retailers-Use Event Location _
I. FILING FREQUENCY:If wage withholding amount is 2. OIL/GAS (1000-Wage
❑51 -56,999/year-Quarterly ❑ $50,000+/year-Weekly ❑ Withholding 750) wrtnnolding (999)$ 0.
0 0
^ Must file by Electronic Funds Transfer Make check payable to
o ❑57,000-$49,999/year-Monthly Cola.Dept.or Revenue
o BOTH WHITE PAGES MUST BE RETURNED. TOTAL $ ♦ —_
s I declare under pfnalty of perjury in the second degree that the statements made in this application are true and complete to the best of my knowledge. _ _
$ SIGNATURE of Owner,PAn h��er or o�r te, �cer REQUIRED Title Date
`CIA 4—:.1 1.11. Organizer X11/28/01 _
OFFICE USE ONLY Account Type Sic Org LC LD
OD IA Siq ❑ N TR-1 Date Tech Siq
070710 2 000 (continue on reverse side of this page.)
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E 1. Has the taxpayer paid any individual that is considered contract or subcontract labor? E Yes E No SIDE B.
a. If YES,describe occupation(s)
2. Does your business activity consist of employee leasing or management of other businesses? ❑ Yes ® No ❑ N/A
3. If the taxpayer is a corporation, are any officers who perform services in Colorado paid wages?• ❑ Yes ❑ No X❑ N/A
4. If the taxpayer is an individual(sole proprietorship),does he/she have any employees other than the
individual, his/her spouse,and his/her children under the age of 21? ❑ Yes ❑ No ® N/A
co co 5. If the taxpayer is a partnership or any type of limited liability organization,does it have anyone performing
m services other than the partners or members of the limited liability organization? ❑ Yes E No ❑ N/A
'if: 6. Has the taxpayer ever paid or expects to pay wages in the state of Colorado? ❑ Yes E No ❑ N/A
F If the answer is NO do not complete the remainder of section G.BE SURE TO SIGN IN SECTION"F"
u If YES,on what date?
o *NOTE:Taxable wages include payments to corporate officers and"dividends"paid in lieu of wages to an officer who performs
services for a S corporation.
n
7a. Effective January 1, 1999,the requirement for unemployment insurance coverage for a business employer has changed from the first payroll date to
o the requirement listed below.The requirements for agricultural, household/domestic,and 501(c)(3)employers have not changed.
i Check the appropriate box and complete 7b.
M ❑ Business Employer.
w A commercial, industrial,or professional organization who pays one or more workers a total of$1,500 gross wages in a calendar quarter
C (Jan.-Mar.,April-June,July-Sept.,Oct.-Dec.)or employs one or more workers in each of any 20 different calendar weeks in a calendar year.
v ❑ Agricultural Workers.
m An agricultural employer who pays one or more employees a total of$20,000 gross wages in a calendar quarter(Jan:Mar.,April-June,
July-Sept.,Oct.-Dec.)or has ten or more employees in each of any 20 calendar weeks in a calendar year.
v
W ❑ Household/Domestic Workers.
A household/domestic employer who pays one or more employees a total of$1,000 gross wages in a calendar quarter(Jan:Mar.,April-June,
July-Sept.,Oct:Dec.).
z ❑ 501(c)(3) Nonprofit Organization.
A 501(c)(3)nonprofit organization who has four or more employees in each of 20 weeks in a calendar year.
7b. On what date did or will you meet the above requirement?
O
a Total gross wages paid in the most recently completed calendar quarter: $
2 How many employees do you currently have?
0
1. Check the description that best describes your business activity in Colorado and explain in detail in box 2 below.
❑ Retail Trade(List what sold and to whom) Construction-General Contractor
❑ Wholesale Trade(List what sold and to whom) Residential Commercial
n ❑ Transportation,Communication&Public Utilities (List type) ❑ Single ❑ Industrial/Warehouse
q ❑ Service(Explain in detail) ❑ Multi ❑ Other than Industrial/Warehouse
C) ❑ Finance,Insurance,Real Estate(Explain in detail) ❑ Speculative Builder/For Sale by Contractor
❑ Agricultural(List crops, animals,&services provided) ❑ Subcontractor(List specialty trade below in#2)
7❑ Manufacturing&Assembly(List products&materials used) Heavy Construction
❑ Mining(List product extracted or service performed) ❑ Highway& Steel Construction
❑ Government(What type of agency) ❑ Bridge,Tunnel& Elevated Highway
O ❑ Household/Domestic ❑ Water,Sewer, Pipeline&Communication
a ❑ Other(Give specific information) ❑ Other Heavy Construction —
2 2. List SPECIFIC products or services and EXPLAIN IN DETAIL.If more than one activity,make ONE a PREDOMINANT percent.(e.g.51-49%)
CC
0
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Z_
I-
W
a 3.Worksite Information- Complete the following for each physical location in COLORADO. For each additional location, copy Section
H and complete.NOTE: If the employee works from home, list the resident address.
m Worksite Physical Address(COLORADO BUSINESS OR RESIDENCE ADDRESS) (Do NOT list P.O. Box or accountant address)
Q Street City State ZIP County
rJ
= Average Number of Monthly Employees Worksite Phone Worksite Contact Person-Please Print
LMI OFFICE USE ONLY CNTY OWN SIC AUX
Acct. No. • CNTY OWN SIC AUX
020711 '_000
APPENDIX B
WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Public Works Department Date: 2/1 2/0 2
1111 H Street,P.O.Box 758, Greeley,CO 80632
Phone: (970)356-4000,Ext. 3750 Fax: (970)304-6497
1. Applicant Name Veteri nary Properties T,TIC Phone 970-351—R185
Address City State_Zip
2. Address or location of access 16751 WCR 64 ( "O" street across from gravel pit)
Section 26(w3se'a) Township 6N Range 6 6
Subdivision Block Lot
Weld County Road # 64 Side of Road N Distance from nearest intersection 3 mile
3. Is there an existing access to the property? Yes x No #of accesses currently a vacant lot
4. Proposed Use:
XX Permanent XX Residential/Agricultural ❑ Industrial
O Temporary O Subdivision O Commercial O Other
***********************************************************************************************************
5. Site Sketch
Legend for Access Description:
AG = Agricultural . Obw
RES = Residential
O&G= Oil&Gas •
D.R. = Ditch Road
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OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation authorized ❑ Information Insufficient
Reviewed By: Title:
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