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Home My WebLink About20040178.tiff . . . . SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL REVIEW (USR) APPLICATION FOR PLANNING DEPARTMENT USE DATE RECEIVED: RECEIPT#/AMOUNT# 1$ CASE#ASSIGNED: APPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number nnnn -nrl-o-® o-E1 o © — (12 digit number-found on Tax I.D.information,obtainable at the Weld County Assessors Office,or www.co.weld.co.us). Legal Description Lot B, RE1467-6-3-RE761 , Section 6 , Township 1 North, Range 68 West Flood Plain: * Zone District: Ag Total Acreage: 3 Overlay District: none known *see. attached Area of Special flood Hazard Elevation Certificate Geological Hazard: yes FEE OWNER(S) OF THE PROPERTY: Name: Loyd and Sheila Schlichenmayer Work Phone# Home Phone#303/828-3013 Email Address Address: 5090 WCR 1 City/State/ZipCode Erie, CO 80516 Name: Work Phone# Home Phone# Email Address dress: //State/Zip Code Name: Work Phone# Home Phone# Email Address Address: City/State/ip Code APPLICANT OR AUTHORIZED AGENT (See Below:Authorization must accompany applications signed by Authorized Agent) Name: Loyd and Sheila Schlichenmayer Work Phone# Home Phone# 303/828-3013 Email Address Address: 5090 WCR 1 City/State/ZipCode Erie, CO 80516 PROPOSED USE: Ag residence -- single family .dwelling unit under Section 23-3-40 and 23-3-20A Asa, 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 ajPfee owners m 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 k D P" signatory has to legal authority to sign for the corporation. W Si ature: ner or Authorized Agent Date ignature: Owner or Authorize ger 2004-0178 r n SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL REVIEW (USR) QUESTIONNAIRE 1. Explain, in detail, the proposed use of the property. RESPONSE: The property is used as an Ag single family dwelling under Weld County Zoning Ordinance applicable to Agricultural Zone and Section 23-3-40, Subparagraph L and Section 23-3-20A. A preexisting residence was located on the property which is occupied by Loyd and Sheila Schlichenmayer. The Use by Special Review would be to use a building constructed in 2000 as a residence (the"Second Residence") to be occupied by Tracy Schlichenmayer, his family, (wife and two children) and Tammy Schlichenmayer and her family(1 child). All persons occupying the Second Residence are related by blood or marriage both in the Second Residence and in the original residence occupied by Loyd and Sheila. This issue arose when Loyd was severly injured in a fall and became unable to work. Sheila cared for Loyd until she injured herself trying to transport Loyd. The children, Tammy and Tracy desired to assist their Mom and Dad and therefore sold their residences, investing the proceeds (over $300,000) in finishing the Second Residence. Unfortunately, the Second Residence was completed without a Use by Special Review permit from the County and without a Building Permit. The purpose of this application is to bring the Second Residence into compliance. The family owns and operates LTS Glass in Erie, Colorado, Tammy is the bookkeeper, Tracy is the principal operating person, and Loyd and Sheila maintain an ownership interest. Attached is a letter dated August 28, 2003, addressed to Kim Ogle at the Weld County Planning Department further detailing the history of this application and which is incorporated into this USR application by reference. If, for no other reason, the Schlichenmayers would request you consider this USR application on the basis of medical hardship. In addition, it is important to note that the living space used by Tammy and her family and the living space used by Tracy and his family in the Second Residence is connected by inner doors and no one lives on the property who is not related to Loyd and Sheila by blood or marriage. 2. Explain how this proposal is consistent with the intent of Weld County Code, Chapter 22 (Comprehensive Plan). RESPONSE: The use is consistent with the Agricultural Zone and Section 23-3-40, Subparagraph L and Section 23-3-20A. The family members living in the Second Residence are related by blood and marriage, both to themselves and to the persons occupying the original residence, i.e., their Mother and Father. 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. RESPONSE: The use is consistent with the Agricultural Zone and Section 23-3-40, Subparagraph L and Section 23-3-20A. The family members living in the dwelling are related by blood and marriage and the Second Residence is connected by inner doors. 1 4. What type of uses surround the site? Explain how the proposed use is consistent and compatible with surrounding land uses. RESPONSE: The uses surrounding the site are Agricultural and Agricultural residences. The proposed use remains consistent with the surrounding land use. 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? d. What type and how many structures will be erected (built) on this site? e. What type and how many animals, if any, will be on this site? f. What kind (type, size, weight) of vehicles will access this site and how often? g. Who will provide fire protection to the site? h. What is the water source on the property? (Both domestic and irrigation). i. What is the sewage disposal system on the property? (Existing and proposed). j. If storage or warehousing is proposed, who type of items will be stored? RESPONSE: a. All are amily members related by blood and marriage occupy the site. Mother and Father occupy the original residence, Tammy and her son and Tracy, his wife and two children. b. There are no employees employed at the site. c. N/A. There are no hours of operation at the site. This is an agricultural residence. d. There is an existing residence occupied by Loyd & Sheila Schlichenmayer, a connecting residence occupied by Tracy Schlichenmayer, his wife and two children, and a connecting residence occupied by Tammy Schlichenmayer and her son. e. The animals located on the property are: Household pets only. f. There will be approximately 5 vehicles accessing the property, i.e., cars and pickups. g. Fire protection is provided by the Mountain View Fire Protection District. h. Water is provided by an existing domestic well. Application for Registration of an Exiting Well is attached. i. The sewage is disposed of by an existing septic system and a permit will be applied for. j. No storage or warehousing is proposed. The storage is limited to equipment used for agricultural purposes and equipment and supplies used for a family glass business. r 2 6. Explain the proposed landscaping for this site. The landscaping shall be separately submitted as a landscape plan map as part of the application submitted. RESPONSE: The landscaping is consistent with other agricultural residences in the immediate area. No new landscaping is anticipated. 7. Explain any proposed reclamation procedures when termination of the Use by Special Review activity occurs. RESPONSE: There are no proposed reclamation procedures. There is no use of the property which requires any reclamation. 8. Explain how the storm water drainage will be handled on the site. RESPONSE: N/A 9. Explain how long it will take to construct this site and when construction and landscaping is scheduled to begin. RESPONSE: There is no anticipated construction. The construction and landscaping has been completed. 10. Explain where storage and/or stockpile of wastes will occur on this site. RESPONSE: N/A. There is no storage or stockpiling of wastes on the site. • 3 r' OCS OTIS, COAN & STEWART, LLC Attorneys And Counselors At Law Fred L Otis flotis@ocslaw.com PJ�!� Cc: C 2 2003 October 24, 2003 T1 BY FAX AND FIRST CLASS MAIL: 970/304-6498 Mr. Kim Ogle Planner III Weld County Planning Department 1555 North 17th Avenue Greeley, CO 80631 RE: Loyd and Sheila Schlichenmayer VI-0300134, Part of SW4SW4 of Section 6, T1N, R68W of 6`h P.M., Weld County, Colorado Dear Kim: This will confirm our conversations over the last several days, and receipt of your October 19, 2003, letter on October 20, 2003. Upon receipt of your letter I immediately advised the Schlichenmayer family of the issues outlined and LuAnnPenfold's October 16, 2003, letter. Several matters need to be brought to your and Ms. Penfold's attention: 1. At the meeting in your office October 6, 2003, between you, the Weld County Building Inspection office representative, Schlichenmayer family, and me, we discussed the windows Tracy Schlichenmayer had already purchased for installation in the bedrooms of the residence were not of the correct size and dimension to be "escape" windows. The windows Tracy has on hand for installation need to be replaced. Since you asked the Schlichenmayers to apply for a building permit, we decided to not take further action until the building plans were approved. Upon receipt of your letter, Tracy immediately ordered the escape windows recommended during the October 6, 2003, meeting. It will take approximately two weeks for the windows to be custom made and a little time thereafter for installation. Thus, the bedroom windows will not be fully installed before October 31, 2003. 2. Ms. Penfold apparently has not been to the residence. There are "hard wired" /'• residential smoke detectors in the residence with a battery backup. We believe there The Doyle Building, 1812 56th Avenue, Greeley,Colorado 80634 Telephone: 970-330-6700 Fax: 970-330-2969 Metro: 303-659-7576 September 3, 2003 Page 2 of 2 is a proper separation from the garage storage area and the living space. In addition, there are fire extinguishers in the residence. 3. Tracy Schlichenmayer has commenced installation of the non-bedroom windows which may be completed as early as this weekend. Regarding the bedroom windows, Tracy advised he will "cut out" the window and temporarily install a Styrofoam knockout which will be installed by this weekend. 4. We do not believe a November 18, 2003, violation hearing is necessary under the above described circumstances. I am not aware of an "already" scheduled November 18, 2003, hearing. Assuming, the Schlichenmayers receive and install the "escape" bedroom windows prior to November 18, 2003, we would hope the hearing would be cancelled. 5. The Schlichenmayers have applied for a building permit pursuant to our October 6, 2003, meeting. There is some confusion in applying for the building permit to complete the special items contained in your October 19, 2003, letter. If you want the Schlichenmayers to apply for a special building permit in addition to the one filed on October 21, 2003, please call me. Sincer ly, Fred L. Otis FLO:mas xc: Mr. and Mrs. Loyd Schlichenmayer Mr. Lee Morrison Weld County Attorney Office PO Box 758 Greeley, CO 80632 /'• OTIS, COAN & STEWART, LLC Am Attorneys And Counselors At Law Fred L Otis flotis@ocslaw.com Weld Count 'Wing Department Oi FICE October 1, 2003 OCT 0 1 2003 HAND DELIVER RECEIVED Mr. Kim Ogle Planner III Weld County Planning Department 1555 North 17th Avenue Greeley, CO 80631 RE: Loyd and Sheila Schlichenmayer VI-0300134, Part of SW4SW4 of Section 6, TIN, R68W of 6th P.M., Weld County, Colorado Dear Mr. Ogle: Attached is a copy of the Schlichenmayer Well Permit No. 252966 for the new USR parcel. I assume this information will now allow you to start processing the application filed with your office on September 8, 2003. Tracy Schlichenmayer and I look forward to meeting with you on October 6, 2003, at 3:00 p.m. Sincerely, Fred L. Otis FLO:mas Enclosure xc: Mr. and Mrs. Loyd Schlichenmayer Mr. Lee Morrison Weld County Attorney Office PO Box 758 Greeley, CO 80632 The Doyle Building, 1812 56th Avenue, Greeley, Colorado 80634 Telephone: 970-330-6700 Fax: 970-330-2969 Metro: 303-659-7576 r^• r.\ OCSOTIS, COAN & STEWART, LLC Attorneys And Counselors At Law Fred L Otis flotis®ocslaw.com September 9, 2003 HAND DELIVER Ms. Monica Daniels Mika Weld County Department of Planning Services 1555 North 17'h Avenue Greeley, CO 80631 RE: Loyd and Sheila Schlichenmayer USR Application for Lot B RE 1467-6-3-RE761, Weld County, a/k/a 5090 WCR 1, Erie, CO 80516 v^• . Dear Ms. Daniels Mika: Loyd and Scheila Schlichenmayer have authorized Fred L. Otis to act as their agent in the enclosed Use by Special Review Application. Attached are the following: 1. Original Use by Special Review Application and 19 copies. 2. 10 copies of Use by Special Review map. 3. 1 8 ''A x 11 copy of Use by Special Review map. 4. Original Use by Special Review Questionnaire and 19 copies. 5. Original Weld County Road Access Information Sheet and 9 copies. 6. One copy of Registration of Existing Well. 7. Septic Permit is being applied for. 8. One copy of Warranty Deed. The Doyle Building, 1812 56th Avenue,Greeley, Colorado 80634 Telephone: 970-330-6700 Fax: 970-330-2969 Metro: 303-659-7576 September 9, 2003 Page 2 of 3 9. One original Certificate of Conveyances. 10. Soils Report is included on Use by Special Review Map. 11. We specially request waiver of an Affidavit and Certified List of Mineral Owners and Lessees because there is no material change to the property. 12. One copy Affidavit and Certified List of Surface Owners within 500 feet of property. 13. Check in the amount of$1,188.00 for application fee. 14. We request the $500 investigation fee not be required. 15. Plat recording fee will be submitted at time of mylar submission. We trust the application is complete and satisfies the County's requirements. If the event you have questions, please call me. Sincerely, Fred L.LL. Otis FLO:mas Enclosures September 9, 2003 Page 3 of 3 Fred L. Otis, Otis, Coan & Stewart, LLC, is authorized to act as agent for Loyd and Sheila Schlichenmayer in all materials and contact with this requested Use by Special Review Application. Loyd Sc 1chenmayer heila Schlic enmayer AREA OF SPECIAL. FLOOD HAZARD ELEVATION CERTIFICATE This form is required to be completed prior to approval of the final inspection when new construction or substantial improvement to existing structures has occurred in an area of Special Flood Hazard_ The lowest floor elevation of structures without a basement shall be considered to be the elevation, above mean sea.level, of the top of the foundation of the structure. The lowest floor elevation of structures with a basement shall be considered to be the elevation, above mean sea level, of the floor of the basement of the structure. The lowest floor elevation of a mobile home shall be considered to be the elevation, above mean sea level, of the top of the mobile home pad. Property fawner.,t l i}`; FJE,II . �C /iE A ..4 f?1 cf 1/e..r'' BP No. 144 7 616 Lr Q 4 Address: -6090 ak ILL lol, fy kocC I City and State: eJ"`I CO Zp: g'S LegaDescription: [�1 S q ,:{1 q (Q-1-(it Description of Building: L/0 Y ( 6/p 7'y ��?, 1911,11 U 111 Does the building have a basement? Yes No To be certified be a Registered Professional Engineer, Architect, or Surveyor. The building described above has been constructed in compliance with Weld County's floodplain management ordinances based or elevation data, visual inspection, and other reasonable means. I certify that the building on the property described above has been constructed with the lowest floor (including basement) at an elevation of feet, above mean sea level and the average grade at the building site is at an elevation of'`. 77.feet, above mean sea level. ® C4 5 4. 6,1z- -2 t 4 s 3c� Certifiers Name Company Name License No. (or Affix Seal) 6/2- SO a 7.eYN*1 0'4'1- 4 d. /_ , o4 Address City State Zip Code i � � X0,51 465 s Signature Ohone {1 <- jdx- Title r Date *° 4430 TO BE COMPLETED BY THE DEPARTMENT OF PLANNING SERVICES FIRM MAP# FHDP No. `' 'it SFVa\ • AREA OF SPECIAL FLOOD HAZARD ELEVATION CERTIFICATE This form is required to be completed prior to approval of the final inspection when new construction or substantial improvement to existing structures has occurred in an area of Special Flood Hazard. The lowest floor elevation of structures without a basement shall be considered to be the elevation, above mean sea level, of the top of the foundation of the structure. The lowest floor elevation of structures with a basement shall be considered to be the elevation, above mean sea level, of the floor of the basement of the structure. The lowest floor elevation of a mobile home shall be considered to be the elevation, above mean sea level, of the top of the mobile home pad. Property Owner.ILo1/ iv-pn8ifa Se...4 t27GL) BPNo. 1 447 C( deco 4 Address: .60 Qt) Rio 1d ui t L4?} -CZ City and State: e %" CO Zip: s/OS/6 LegaDescription: (�j S %t1 q S uJ q Description of Building: 0 X a,0 'c,7 P ty acs 1bl 1I d ry Does the building have a basement? Yes t No To be certified be a Registered Professional Engineer, Architect, or Surveyor. The building described above has been constructed in compliance with Weld County's floodplain management ordinances based on elevation data, visual inspection, and other reasonable means. f certify that the building on the property described above has been constructed with the lowest floor (including basement) at an elevation of i fQ 79 feet, above mean sea level and the average grade at the building site is at an elevation of f/_977. feet, above mean sea level. l © aX15 4. 4/Y Z "pi_ 2 4 S /36 Certifiers Name Company Name License No. r ? (or Affix Seal) /j-- t/ e r T 9004. Address City State / Zip Code Signature phone J Z. Itt, �, � � Title Date GL-CA 443 TO BE COMPLETED BY THE DEPARTMENT OF PLANNING SERVICES k FIRM MAP# FHDP No. A'"re OF 4‘1 %) FLOOD HAZARD DEVELOPMENT PERMIT CERTIFICATION I certify that the following standards have been met: (Check applicable sections only) )( The lowest floor, including the basement floor, is elevated (for existing structures which are being substantially improved)or will be built(for new structures)to the level, or above, of the regulatory flood datum. Water Surface Elevation of the Intermediate Regional Flood is: 119 7 7 feet above MSL at the building site. Elevation of the lowest floor of the proposed structure is 2- feet above MSL at the building site. _ The mobile home pad is elevated (for existing structures which are being substantially improved) or will be built(for new structures) to the level, or above, of the regulatory flood datum. Water Surface Elevation of the Intermediate Regional Flood is: a feet above MSL at the building site. Elevation of the mobile home pad is feet above MSL at the building site. X/ The lowest floor of the manufactured home, including the basement floor, is elevated (for existing structures which are being substantially improved) or will be built(for new structures) to the level, or above, of the regulatory flood datum. Water Surface Elevation of the Intermediate Regional Flood is:2S77 _feet above MSL at the building site. �► Elevation of the lowest floor of the retaltredlome4ris 99 7® feet above MSL at the building site. £141 o-n 'rade . r /=/oo<JF lain nit;rweriom Pao,' Coritett C Flood p/a,+t haneycnne,,l Source of Information: P/eun for .Cpat< Cite k.). ci Erie . Colo r•ado Av Wafor Reyauraes CorsuHaxys4I',.c Thrust /480 Structures which are not elevated in order to be floodproofed are designed so the structure is watertight below the elevation of the regulatory flood datum and the structures are designed to be capable of resisting the hydrostatic and hydrodynamic forces expected at the building site during an intermediate regional flood. Water Surface Elevation of the Intermediate Regional flood is: feet above MSL at the building site. Elevation to which structure is to be floodproofed and watertight: feet above MSL at the building site. Source of Information: Q fr All new or replacement domestic water wells or water supply, treatment, or storage systems are designed to prevent inundation or infiltration of floodwater into the system by an intermediate regional flood. Jd I1-- All new or replacement sanitary sewer systems are designed to prevent inundation or infiltration of floodwater into the system and to prevent discharges from the systems into the floodwater of an intermediate regional flood. Y The encroachments, including fill, new construction, substantial improvements, and other development shall not result in any increase in flood levels during the occurrence of an Intermediate Regional Flood. Rev'54 /Z//2°°° 7 FLOOD HAZARD DEVELOPMENT PERMIT CERTIFICATION I certify that the following standards have been met: (Check applicable sections only) )( The lowest floor, including the basement floor, is elevated (for existing structures which are being substantially improved) or will be built(for new structures) to the level, or above, of the regulatory flood datum. Water Surface Elevation of the Intermediate Regional Flood is: JJ9 7 7 feet above MSL at the building site. • Elevation of the lowest floor of the proposed structure is 2- feet above MSL at the building site. The mobile home pad is elevated (for existing structures which are being substantially improved) or will be built(for new structures) to the level, or above, of the regulatory flood datum. Water Surface Elevation of the Intermediate Regional Flood is: Z. feet above MSL at the building site. Elevation of the mobile home pad is feet above MSL at the building site. )( The lowest floor of the manufactured home, including the basement floor, is elevated (for existing structures which are being substantially improved) or will be built(for new structures) to the level, or above, of the regulatory flood datum. Water Surface Elevation of the Intermediate Regional Flood is:J( Z7 _feet above MSL at the building site. Elevation of the lowest floor of the ° sir ome is 19 fig., feet above MSL at the building site. 5 Ica) o n y rade— t. joo,Jp!an7 rn{o r-rna'f/o')1, need Co nt co GloolpIan; C1e',fe9GTle,,l Source of Information: ,r a,r (o✓ .!Pat Cvice k of Erie •. Co/o IQ dby 0214-kv Re '�oufltS Co-++sulia7r(s, Z"IC_ Alyust i96d Structures which are not elevated in order to be floodproofed are designed so the structure is watertight below the elevation of the regulatory flood datum and the structures are designed to be capable of resisting the hydrostatic and hydrodynamic forces expected at the building site during an intermediate regional flood. Water Surface Elevation of the Intermediate Regional flood is: feet above MSL at the building site. Elevation to which structure is to be floodproofed and watertight: feet above MSL at the building site. Source of Information: At Q^ All new or replacement domestic water wells or water supply, treatment, or storage systems are designed to prevent inundation or infiltration of floodwater into the system by an intermediate regional flood. V 4. All new or replacement sanitary sewer systems are designed to prevent inundation or infiltration of floodwater into the system and to prevent discharges from the systems into the floodwater of an intermediate regional flood. ,x The encroachments, including fill, new construction, substantial improvements, and other development shall not result in any increase in flood levels during the occurrence of an Intermediate Regional Flood. I levls4 /Z//2uoo 7 FLOOD HAZARD DEVELOPMENT PERMIT CERTIFICATION -Continued r S, Electrical, heating, ventilation, plumbing, and air-conditioning equipment and other service facilities will be designed and/or located so as to prevent water from entering or accumulating within the components during conditions of flooding. . )( All new construction and substantial improvements will be constructed using methods and practices that minimize flood damage. Improvements will be constructed with materials and utility equipment resistant to flood damage. X All new construction and substantial improvements will be anchored to prevent flotation, collapse or lateral movement of the structure and to withstand hydrodynamic loads. The proposed use or structure is to be located in the FW(Floodway) District, and when built will not cause any increase in floodwater levels during an Intermediate Regional Flood and will not limit or restrict the flow capacity of the floodway. X Fill material will be used in the FP-1 or FP-2 (Floodprone) Districts, and the fill material is designed to withstand the erosional forces associated with an Intermediate Regional Flood. The use or development causes or results in an alteration or relocation of a water course. Evidence is attached to this certification that: 1. Municipalities within a three-mile radius of the proposed alteration or relocation have been notified in writing of the proposed alteration or relocation. 2. The Colorado Water Conservation Board has been notified in writing of the proposed alteration or relocation. 3. The Office of Insurance and Mitigation of the Federal Emergency Management Agency has been notified in writing of the proposed alteration or relocation. X The flood carrying capacity within the altered or relocated portion of the watercourse will remain the same after the alteration or relocation as existed prior to the alteration or relocation. Evidence is attached which substantiates that the alteration or relocation shall not adversely affect landowners upstream or downstream from the alteration or relocation. Date: Property Owner o Dcf/S .R / 17 ee�, l��i/�f�D Date: -3-/a/ y -�zl �� 61OO Registered Professional Engineer State of Colorado 2ewsed (0!2 So 5er-insbnf /41) 2. /.;a.f4,, fie Co 790L(,, 00y y 6 ‘C --5---6-518 ir . 1r 8 FLOOD HAZARD DEVELOPMENT PERMIT CERTIFICATION -Continued ,^ S, Electrical, heating, ventilation, plumbing, and air-conditioning equipment and other service facilities will be designed and/or located so as to prevent water from entering or accumulating within the components during conditions of flooding. A All new construction and substantial improvements will be constructed using methods and practices that minimize flood damage. Improvements will be constructed with materials and utility equipment resistant to flood damage. )( All new construction and substantial improvements will be anchored to prevent flotation, collapse or lateral movement of the structure and to withstand hydrodynamic loads. _ The proposed use or structure is to be located in the FW(Floodway) District, and when built will not cause any increase in floodwater levels during an Intermediate Regional Flood and will not limit or restrict the flow capacity of the floodway. X Fill material will be used in the FP-1 or FP-2 (Floodprone) Districts, and the fill material is designed to withstand the erosional forces associated with an Intermediate Regional Flood. The use or development causes or results in an alteration or relocation of a water course. Evidence is attached to this certification that: 1. Municipalities within a three-mile radius of the proposed alteration or relocation have been notified in writing of the proposed alteration or relocation. 2. The Colorado Water Conservation Board has been notified in writing of the proposed alteration or relocation. /''•• 3. The Office of Insurance and Mitigation of the Federal Emergency Management Agency has been notified in writing of the proposed alteration or relocation. X The flood carrying capacity within the altered or relocated portion of the watercourse will remain the same after the alteration or relocation as existed prior to the alteration or relocation. Evidence is attached which substantiates that the alteration or relocation shall not adversely affect landowners upstream or downstream from the alteration or relocation. Date: Property Owner I,, Dcf15 12. />g7, f t i/4 D Date:_-3-/c./ /Z�'oa Registered Professional Engineer i 2eulit State of Colorado 412- //'�So B -*in erl /4UC k,4 TG t 1-1-eCo 7002-(p �j o y ors --5-5348 tJ w</ ki.A.' -0 1 . • t lire ply ✓ 8 OICS OTIS, COAN & STEWART, LLC Attorneys And Counselors At Law Weld County Planning Department Fred Otis GREELEY OFFICE flotis@ocslaw.com SEP 0 2 2003 air\ RECEIVED vV September 2, 2003 HAND DELIVER Mr. Kim Ogle Planner III Weld County Planning Department 1555 North 17u' Avenue Greeley, CO 80631 RE: Loyd and Sheila Schlichenmayer VI-0300134, Part of SW4SW4 of Section 6, TIN, R68W of 6t°P.M., Weld County, Colorado Dear Mr. Ogle: I received a copy of the July 8, 2003, Weld County Building Code Violation Notice to Loyd and Scheila Schlichenmayer, and an additional notice dated August 13, 2003, scheduling a meeting with the Board of County Commissioners September 9, 2003, at 10:00 a.m. First, I met with you August 6, 2003, in an effort to find a solution to the dilemma facing Mr. and Mrs. Schlichenmayer. During our meeting I believed we were attempting to resolve the issues. Mr. and Mrs. Schlichenmayer remain ready and willing to file both a building permit application and a use by special review request. Accordingly, this is to provide insight into the Schlichenmayers' personal situation and suggest a resolution which meets and complies with the Weld County Building Code and Zoning Ordinance. A little history: Mr. and Mrs. Schlichenmayer purchased the referenced property in 1998. Where the pole barn was eventually constructed there were some unattractive corrals and outbuildings. The Schlichenmayers, as a family, operate LTS Glass in Erie, Colorado. Tammy, daughter, is the bookkeeper, and Tracy, son, (at this point) runs the business. On October 3, 1996, Loyd Schlichenmayer fell from a 16 foot scaffold. Loyd landed on his feet on concrete, stiff legged. He broke his sternum, both ankles, and a vertebra in his lower back. The channel that holds the nerve endings below the spinal cord was severely crushed. The surgery on his back took 7 hours, and the surgery on his ankles took 7 hours. The surgeon on each ankle had to remold the ankle joints from bone removed from his pelvic area. Loyd, since that time, has The Doyle.Building, 1812 56th Avenue,Greeley,Colorado 80634 Telephone: 970-330-6700 Fax: 970-330-2969 Metro: 303-659-7576 • September 2, 2003 Page 2 of 3 severe chronic pain down the left leg, and only returned to work because he was one of the owners. He worked with severe pain. Finally, Loyd was unable to work. Loyd's wife, Sheila, tried to take care of Loyd, but ruptured a disc in her back from trying to carry him. Sheila spent a week in the hospital from the injury. Sheila has been diagnosed with severe osteoporosis. In early 2000 it was decided to construct an 8,000 square foot pole barn on the Schlichenmayer property. On February 18, 2000, they applied for a building permit which was granted May 19, 2000. Final inspection of the building occurred September 11, 2000. Despite, how it may appear, there was no plan to finish the barn as a residence for Tammy and Tracy until November 2000 when the family decided Sheila needed help in caring for Loyd. Coincientially, Tammy's fiance, with whom she was living at the time, died at age 35 of a massive coronary. Tammy lived 15 miles from the Schlichenmayer residence, and Tracy lived - . 10 miles from the residence. In any event, after much discussion among the family members, the Schlichenmayers decided they all needed to live in one place so they could assist each other. A plan was put in place to complete the pole barn. The attached drawing (Exhibit A) shows the approximate square footage in each portion of the pole barn. Roughly stated, Tracy's portion is approximately 1,920 square feet, and Tammy's portion is approximately 1,920 square feet, and the two areas are connected by internal doors, and a 1,280 square foot garage. The remainder of the building is committed to agriculture and storage purposes. Tammy and her son moved into Loyd and Sheila's residence in September 2001, and then moved into the pole barn residence in November 2001. Tracy and his family moved to the pole barn residence in February 2002. Both Tammy and Tracy sold their respective prior residences and committed over $300,000 to refinishing the pole barn (in addition to the initial cost of the pole barn). Each of the Schlichenmayers has expressed their regret in failing to obtain the proper permits at the time the pole barn was finished as a residence. However, the Schlichenmayers are willing to immediately apply for a Building permit and Use by Special Review permit. I am attaching a drawing (Exhibit B) of how the property has been finished, and an application for a building permit will be promptly submitted. In addition, I reviewed the Weld County Zoning Ordinance relevant to the Agricultural zone and Section 23-3-40, Subparagraph L appears to allow a use by special review for a single family dwelling unit per lot other than those permitted under Section 23-3-20A. It appears the use by special review can be restricted to a single family dwelling unit in addition to the single family dwelling allowed by right under Section 23-3-20A Moreover, since the portion of the pole barn principally occupied by Tammy and the portion principally occupied by Tracy are connected by interior doors, and all family members are related by blood or marriage, the single family requirements have been met. All the individuals occupying the pole barn are related by blood and marriage, and have inner doors connecting the living areas. The Schlichenmayers are willing to consider other restrictions on the Use by Special Review permit which the County may impose to assure the Schlichenmayers use of the pole bad residence is not abused. r September 2, 2003 Page 3 of 3 Attached is an application for Late Registration of a Well (Exhibit C). Hopefully it will resolve the water issue. There is a separate leachfield and septic system that we will promptly ask the Weld County Health Department to approve it. We know of no reason why these applications will not be approved. Attached are copies of letters from Tammy and Tracy Schlichenmayer, a letter dated February 1, 2003, from Sheila Schlichenmayer to the Mayo Clinic regarding Loyd's pain and request for assistance, and other pertinent information(Exhibit D. We are unaware of any opposition from any person or neighbors regarding this matter. We will obtain letters from surrounding property owners for submission as soon as we receive them. I implore you to consider this request from the Schlichenmayers. They have a medical condition, and significant funds have been expended to modify the pole barn into a livable residence. Sincerely, rOefie Fred L. Otis FLO:mas Enclosures xc: Mr. Bruce Barker Weld County Attorney Ms. Peggy Gregory Building Compliance Officer Weld County Building Inspection Mr. and Mrs. Loyd Schlichenmayer Saki/ enMayer flick Q- ,ti rain MI G-ary Pi Tracy h Dor raTh FEBRUARY 1, 2003 MAYO CLINIC CHRONIC PAIN DIVISION ROCHESTER, MN 55905 DEAR CHRONIC PAIN DIVISION, I AM WRITING AS A LAST RESORT FOR MY HUSBANDS' PAIN. IN 1996 AT THE AGE OF 58, HE FELL 16' FROM A SCAFFOLD. HE LANDED ON HIS FEET, STIFF LEGGED, ON CONCRETE. THIS SHATTERED BOTH ANKLES, BROKE HIS STERNUM AND BROKE A VERTEBRA IN HIS LOWER BACK. ALSO THE CHANNEL WHERE THE NERVES RUN BELOW THE SPINAL CORD WAS FLATTENED. THIS IS WHERE THE PROBLEM IS. THE SCIATICA NERVE FROM THE CHEEK OF HIS LEFT BUTTOX DOWN THROUGH THE FOOT. WE HAVE TRIED EVERYTHING FROM ACUPUNCTURE TO HYPNOSIS AND BEYOND. RIGHT NOW HE HAS A PAIN PUMP WHICH HAS GOTTEN HIM OFF ORAL MEDICATION BUT THAT IS ALL. HE STILL HAS SO MUCH PAIN IT'S HARD FOR HIM TO FUNCTION. HE RECEIVES 13 MILLIGRAMS OF MORPHINE PER DAY THROUGH THE PUMP. TO KEEP RAISING THE DOSAGE COULD RESULT IN THE CRYSTALLIZATION AT THE END OF THE CATHETER. WE EVEN ASKED ABOUT CLIPPING THE NERVE, BUT WERE TOLD HE WOULD DRAG HIS LEG AND PROBABLY HAVE PHANTOM PAINS WHICH ARE TWICE AS BAD AS THE PAIN HE HAS NOW. WE WERE TOLD SOME PEOPLE HAVE COMMITTED SUICIDE FROM THESE PHANTOM PAINS. WE ARE AT OUR WITS END. WE HAVE KAISER INSURANCE WHICH HAS PAID GREAT, BUT WE ARE AT A PLACE WHERE WE DON'T KNOW WHERE TO TURN. COULD THERE BE ANYONE, ANYWHERE THAT MIGHT BE ABLE TO HELP US ?? I HAVE NOT APPROACHED OUR INSURANCE UNTIL I KNOW SOMETHING. WE WOULD APPRECIATE ANY INFORMATION YOU COULD GIVE US. SINCERELY, SHEILA SCHLICHENMAYER HUSBAND: LOYD SCHLICHENMAYER 5090 WCR#1 ERIE, CO 80516 PHONE: 303-828-3013 FAMILY IS THE WORLD TO US.'NOT ONLY DO WE WANT TO LIVE TOGETHER AS A FAMILY, WE OWN AND OPERATE A FAMILY BUSINESS TOGETHER. AFTER DADS ACCIDENT, WE DIDN'T THINK HE WOULD EVER WALK AGAIN, LET ALONE WORK AGAIN. WHEN HE WAS ABLE TO WALK AND EVENTUALLY RETURN TO WORK, WE WERE ALL VERY RELIEVED. HOWEVER AS TIME WENT ON, IT WAS VERY OBVIOUS THAT HE COULD NOT CONTINUE ON WORKING. IT WAS, AND STILL IS,VERY PAINFUL TO WATCH YOUR OWN FATHER GO DOWN HILL. HE COULD NO LONGER HELP MOM LIKE HE COULD BEFORE. DURING ALL OF THIS, MOM TOOK ON ALL THE EXTRAS INCLUDING HELPING DAD AND ENDED UP IN THE HOSPITAL WITH A RUPTURED DISC. SHE WAS LATER DIAGNOSED WITH OSTEOPOROSIS. I LIVED 15 MILES AWAY AND TRACY LIVED 10 MILES AWAY. WE WERE MAKING LOTS OF TRIPS TO HELP AS MUCH AS WE COULD. SINCE OUR FOLKS HAD ALREADY HAD THE BUILDING PUT UP FOR SOMETHING ELSE, WE ALL DECIDED IT WOULD HELP EVERYONE IF WE MADE IT LIVABLE SPACE. ALTHOUGH WE KNOW IT WASN'T THE RIGHT WAY TO DO IT, IT WAS THE BEST WAY TO HELP OUR PARENTS AND OURSELVES. DURING CONSTRUCTION, MY FIANCE WHO WAS THE PLUMBER AND HAD COMPLETED THE UNDERGROUND, PASSED AWAY. HE WAS ONLY 35 AND HAD A MASSIVE CORONARY. IT GOT HARDER NOT ONLY EMOTIONALLY, BUT ALSO FINANCIALLY. MY FAMILY HELPED ME SELL MY HOUSE AND MOVED MY YOUNG SON AND I IN WITH MY PARENTS UNTIL CONSTRUCTION WAS FINISHED. AFTER ALL OF THIS, WE REALLY WANTED TO BE THERE FOR EVERYONE AS A FAMILY. TRACY AND HIS FAMILY LATER SOLD THEIR HOME AND WILLINGLY MOVED THERE. IT HAS BEEN A GOD SEND TO LIVE THERE. NOT ONLY CAN WE ALL BE THERE TO TAKE CARE OF THINGS, BUT OUR 20 YEAR BUSINESS HAS HAD SOME FINANCIAL TROUBLE THIS LAST YEAR. WE WERE ABLE TO KEEP IT GOING BY NOT TAKING PAYCHECKS BECAUSE WE DIDN'T HAVE HOUSE PAYMENTS. THINGS ARE COMING AROUND BUT IT HAS BEEN VERY DIFFICULT. THE BOTTOM LINE IS, WE LOVE OUR FAMILY AND IT WOULD NOT ONLY BE EMOTIONALLY DEVASTATING BUT ALSO FINANCIALLY DEVASTATING TO HAVE TO LEAVE. OUR PARENTS HAVE DONE MORE THAN YOU COULD, IMAGINE FOR US. NOW IT IS OUR TURN TO DO FOR THEM. TAMMY SCHLICHENMAYER TRACY SCHLICHENMAYER EXHIBIT D Pre-Interview Fact Sheet Please answer the following questions as completely as possible. This form will assist us in the completion of your claim. Bring this fora with•you to the interview or have readily available for your telephone interview. Proof of this information may be required. Your. Name: „La yd .het ' S //Gilt Maytr SSN: say- 4 t LIIS Mailing Address: SO 90 Li.J C R I i City: _er/P_ State: co Zip Code: 7.057 , .Telephone: (bs Ifl-34013 • Date of Birth: /C-/C 25Place of Birth:24r/i aptn n ('at Do you have an Original or Certified Birth Certificate? es No (circle) Dates of Active Military Sere iced! "—Are you currently working?: Yes (circle) Employer's Name:173 -/Q S JY!C-' . Employer's Address: 0'1700 S „ &iJ n csr . £i t 2,p %U •Earnings for last year: Wages S • Self-Employment S • Current year earnings: Wages S Self-Employment S • Do you.have any Biological or Adopted.children? CD No (circle) Please list any children age 19 or younger or any disabled adult children: • • NAME. . Date of birth SSN • NOW • *******A*******************!************************************************#* Have yon ever worked for the City, State, or Federal Government? . Yes o • (circle) Are you disabled? es No (circle) ii Yes, when did you become disabled or unable to work because of your disability? /—/-10.2.• (OVER) • ate► PLEASE COMPLETE THIS QUESTIONNAIRE BEFORE YOUR INTERVIEW CR NAME: ✓ d Zee. 3'Al/('f'1PYlm r YOUR SSN: 54411 41///I/S ADDRESS: Sr ' U/CR / PHONE #: (3 Q3) DOB: 10- / G- 1 ? DO YOU HAVE A BIRTH CERTIFICATE? Cy?"' NO YOUR CURRENT OR LAST MARRIAGE TO WHOM MARRIED: 5 h Q.! I a- Sc i 11 cJi en m a ytr WHEN: 7-ah- G o 1/4.13Q(1,I der- HOW MARRIAGE ENDED: /1 WHERE: SPOUSE'S DATE OF BIRTH: -AP-S cl IF SPOUSE DEACEASED-DATE: *1 SPOUSE'S SSN: Saa- Y&-S3617 T ' PRIOR MARRIAGE TG WHOM MARRIED: WHEN(month, day, year): n. WHERE: HOW MARRIAGE ENDED: i#, WHEN: WHERE: {�► SPOUSE'S DATE OF BIRTH: IF SPOUSE DEACEASED-DATE: irk- SPOUSE'S SSN: PLEASE LIST ADDITIONAL MARRIAGES ON A SEPARATE SHEET OF PAPER. ALSO,IF YOU ARE FILING FOR WIDOW(aES OR DIVORCED SPOUSE'S BENEFITS, COMPLETE THE SAME MARRIAGE INFORMATION AS REQUESTED ABOVE REGARDING YOUR SPOUSE'S PRIOR MARRIAGES, DO THIS ON A SPPARATE SHEET OF PAPER DO r HAVE ANY CHILDREN UNDER 19? If yes, list the'names, dates of birth and SSN: NAMJ:.S: DOB: SSN: 14(er v1ORE QUESTIONS ON BACK Form Approved SOCIAL SECURITY ADMINISTRATION OMB No oneooe79 For SSA Use Only DISABILITY REPORT Do not write in this box. ADULT Related SSN Number Holder SECTION 1- INFORMATION ABOUT THE DISABLED PERSON A. NAME (First, Middle Initial, Last) B. SOCIAL SECURITY NUMBER kind L. Sc�keile,Y1 tat .a,r Sat/- 41- 1 l (S C. AYTIME TELEPHONE NUMBER (If ou have no number where you can be reached, give us a daytime number where we can leave a message for you.) t. ...3121 RA 8'- 301_ Area Number Your Number ❑ Message Number ❑ None Code • a D. Give the name of a friend or relative that we can contact (other than your doctors) who m knows about illnesses, injuries or conditions and can help you with your claim. g "r NAME 1 / . ,S'eji i /ejje Y) YY) a/ ar RELATIONSHIP Sto y2 70 9 n ADDRESS set e G1 R ) a r /Number,Street,Apt. Noll/any),P.O. Box,.or Aural Route) D a Erie- ('.0 fo siC. DAYTIME 31,3 7i 9- �/3 '3 City State ZIP PHONE Aran Code Number o 0 E. What is your F. What is your weight 3 height without —eat — without shoes? —1 a) shoes? a,chee pounds G. Do you have a medical assistance card? (For Example, Medicaid ❑ YEs tg NO 0) (?)or Medi-Cal) If "YES," show the number here: do '; H. Can you speak English? ZYES ❑ NO If "NO," what languages can you speak? If you cannot speak English, is there someone we may contact who speaks English and will give you messages? (If this is the same person as in D"above show "SAME"here.) NAME RELATIONSHIP r ADDRESS 1 j Wu ,Street,Apt. Na.(N any), P.O. Box, or Rural Route) t DAYTIME City y State ZIP PHONE Area Coda Number 1. Can you read English? tit YES ❑ NO J. Can you write more than x YES n NO your name in English? M SSA-3368-BK (11-2001) EF (11-2001) The 12-1998 edition may be used until exhawted PAGE 1 C - SECTION 2 1 YOUR ILLNESSES, INJURIES OR CONDITIONS AND HOW THEY AFFECT YOU A. What are the illnesses, injuries or conditions that limit your ability to work? Metal _ IA boi'h o nA(les - metal in lower-19,2c,J< 4- se-l'tr-r chirF)n«, I �0-%�1 -Nan lisrvt darn g, in ba_c-� — How do your illnesses, injuries or conditions limit your ability to. work? ya,rtL --t"© — u a]!K- p a Abet y -4. ttVlccJ9I,# -1-79 /is i- ,t-- — pjpsL)raticn a r s my &,i/- brig u.)n• - C. Do your illnesses, injuries or conditions cause you pain of YES ❑ NO or other symptoms? D. When did your illnesses, injuries or _ month — X�y conditions first bother you? J 7' E. When did you become unable to work because w7rn Year of your illnesses, injuries or conditions? !. F. Have you ever worked? N YES ❑ NO (If 'NO,'go to Section 4.) G. Did you work at any time after the date your — illnesses, injuries or conditions first bothered you? IX YEs ❑ NO H. If "YES," did your illnesses, injuries or conditions cause you to: (check all that apply) — g work fewer hours? (Explain below) — g change your job duties? /Explain below) At g make any job-related changes such as your attendance, help needed, or employers? FC (Explain below) , C( cu* h,ourc woriada clic' l ip4t cve ahop work sic could ndf ,r 4 kic.entmt, `t-® etc 4bl ti'e pint- uVoH k. worKttL my OuW11 hours 9 Ni' up I. Are you working now? ❑ YES ' til NO )' Year If "NO," when did you stop working? '"h y Pj 2 J. Why did you stop working? 'Pt;vi ,2etal7Fi flp ses_},t__, A< /" )RI FORM SSA-3368-8K (11-2001) EF (1 1-2001) The 12-1998 edition may be used until exhausted PAGE: SECTION 3 - INFORMATION ABOUT YOUR WORK A. List the kinds of jobs that you have had in the last 15 years that you worked. r C _ a 4,s .4, .1 rfE 3 x 1 7 r JOB TITLE c 440 ' s" "` xF f E " Ays RATE OF PAY T 11(ehear. s p Ne"!1,421* a G)aziER 4-(thinaSr Glass Shop /o- ' 1-02-- l2 ro $ vat; / .. r s • $ $ $ $ B. Which job did you do the longest? Own hu,5j12,,,,45 sfa /9P�f�oirca, it C. Describe this job. What did you do all day? (If you need more space, write in the "Remarks" section.) N- earm %aif ; � p�d b1 Fr;;it c- d ;d tkt crMs. r ` D. In this jolt, did you: Use machines, tools or equipment? cs YES 0 NO Use technical knowledge or skills? Er YES 0 NO Do any writing, complete reports, or perform duties like this? jgl YES *'NO E. In this job, how many total hours each day did you: Walk? _ Stoop? (Bend down&forwarder waist.) Handle, grab or grasp big objects? Stand? _ Kneel? (Bend legs to rest on knees.) Reach? Sit? Crouch? (Bend legs&beck down&forwent) Write, type or handle small objects? Climb? Crawl? (Move on hands&knees.) �/o r- � d-e co sisrd o A cZ/Colt ?hie ct-ter e- F. Lifting d Carryi g ( plain w t you lifted, how far you carried it, and how often you did this.) thor� - s U IThD tiJPJ v tai't't'd a s �izr c�. �2DD ' da +111.5 et/el/ CM)/ G. Check heaviest weight lifted: 0 Less than bibs ❑ 10 Ibs ❑ 20 Ibs ❑ 50 Ibs El 100 lbs. or more ❑ Other H. Check weight frequently lifted: (By frequently, we mean from 1/3 to 2/3 of the wofkday.) ❑ Less than bibs ❑ 10 Ibs ❑ 25 lbs 50 lbs. or more ❑ Other I. Did you supervise other people in this job? .glYES (Complete items below.) ❑ NO (Skip to next page.) How many people did you supervise? Y What part of your time was spent supervising people? 3 0 `4 Did you hire and fire employees? cgiYES ❑ NO J. Were you a lead worker? YES ❑ NO FORM SSA-3368-8K (11-2001) EF (11-2001) The 12-1998 edition may be used until exhausted PAGE 3 C SECTION 4 - INFORMATION ABOUT YOUR MEDICAL RECORDS A. Have you been seen by a doctor/hospital/clinic or anyone else for the illnesses, injuries or conditions that limit your ability to work? X YES ❑ NO B. Have you been seen by a doctor/hospital/clinic or anyone else for emotional or mental problems that limit your ability to work? ❑ YES RI NO If you answered "NO" to both of these questions, go to Section 5. C. List other names you have used on your medical records. Alone- Tell us who may have medical records or other tiinformation about your illnesses, injuries or conditions. — D. List each DOCTOR/HMO/THERAPIST/OTHER..Include your next appointment. fl 1. NAME — .Dr Stephen teal �. xr r STREET ADDRESS 3 EJRb lIS1T 93 14 � --3-9 CITY �p l��r �S tb ZIP 1D309 LAST SEEN /0 Lt_r PHONE _log 44947 10 CHART/HMO # (If known) NEXT APPOINTNIENT Ar.n cad. Phone Mann. N/19 REASONS FOR VISITS f/./ Ave/ sccdhid_ Tj-/?a,/ rgnw/dam tv/I, iyn kit joints. cn Sept aDQo Dr l uJ had "In - 'l-u.sc, +he Lek iWio d(mot +9 paiY1, WHAT TREATMENT WAS RECEIVED? 7 e f y/5/'ve_. s-t/!/u/'1/ 7`U both ,zn (f6S Al // Cl 2. NAME t ' r x2:74. azt.t .r 'ids ; Sic yr- Wit _ 1 a en (Nc / 'J C1m s d " � STREET ADDRESS FIRST VIS�0- f 933 14 o,vi 3-9G -0 CITY !)bui d 3 eiZIP po.3ow' LAST SEEN Wi d PHONE 1 3 � L�/�Q_�, Q CHART/HMO # (If known) NEXT APPOINTMENTtw _ J Ann ful REASONS FOR VISITS Fit! -Pr4m Se a449 - Dr tut lions rejOClLret brokyn ✓4rSbru. ; n back- rpaireL nerve- daenaa divvied WHAT TREATMENT WAS RECEIVED? J• X -1-615/1/€., S IV louder- loccc k 0ici. d h&rk Stdv coy din to role ;gins i n rn t+thi r n SAX 1�l 791 — i ns er-teed e.g 1 s i yn u.l cctnr OR cnoaa CCA_' iAR.RK (11A l flfl 1 FP 111_9(N11/1 The 1n_,0012.. t..n ...e.o i..,..ew n.,t,,e.a.w..,er, oar_ SECTION 4-INFORMATION ABOUT YOUR MEDICAL RECORDS .- DOCTOR/HMO/THERAPIST/OTHER 3.NAME, } i im wt ,s +t iai3> .1/r. Kar#..n S7a si K 3.R'��f+�� , 17,„,4,.,.x4-. r E'^'Y ,. yt xa STREET ADDRESS ' J n,�rh nee, FIRST VISIT/ 999 CITY�en v ST dU ZIP &0�5 LAST SEEN 7 MO Stir PHONE`�al ire/. 3-/0 CHART/HMO # (If known) NEXT APPOINTMRIT Am.Code Phone Number "If REASONS FOR VISITS _E`OJ the i sizes °r U:CGup1/. rture. WHAT TREATMENT WAS RECEIVED? Set a.,kuled If you need more space, use Remarks, Section 9. E. List each HOSPITAL//CLINIC. Include your next appointment. �3 ,. @� 1 P•i: t ₹, ,.u... SI*14:14 n�a. +n �fi ix:> 'y i f f.X f ,4f y49M ;'r a3₹ :ii r r- NAME INPATIENT ;;.(a��attat <v1 �ti �t STAYS / -'3-9(/ mi Crt J�OtGddP.r �Dlllrllll�?i / (Stayed at/east 741-00 9-30-00 STREET ADDRESS // avernigho I`0,0 ga'Q'i OUTPATIENT 171:7, — ? ' `, _1,792 , CITY STATE ZIP VISITS /Sent hone same Soutar Co Sogoli e deo PHONE EMERGENCY In 4i4sO_d'g73 ROOM VISITS LO 3- U. a,.,Cade vnw.M.,m Next appointment hiln Your hospital/clinic number 323 41q -2.v3O Reasons for visits t hk Ups /n c What treatment did you receive? aid x < s to ke_ S W' - Ptvc eerkita s t.vtrt worki'n f What doctors do you see at this hospital/clinic on a regular basis? P-- 1k1 /7r Williams FORM SSA-3368-8K (11-2001) EF (11-2001) The 12-1998 edition maybe used until exhausted PAGE 5 SECTION 4-INFORMATION ABOUT YOUR MEDICAL RECORDS HOSPITAL/CLINIC 2. ['0SPI`}`AUCL)NIC„ N ps S ".i:4:4 a NAMEINPATIENT wM sn k J.' St crcstioh c (SSTAYS at -ltO 11-a7-O.1 STREET ADDRESS overnight) �3s Erthik1; )1 ❑ OUTPATIENT CITY STATE ZIP VISITS (Sem home same tali/ ire 3Nff, PHONE EMERGENCY 3 D3 IJ I-11/I ROOM VISITS An..Code vnoa.weep. Next appointment M 1)4 Your hospital/clinic number Reasons for visits 0.. What treatment did you receive? What doctors do you see at this hospital/clinic on a regular basis? 11- J) below 5 If you need more space, use Remarks, Section 9. F. Does anyone else have medical records or information about your illnesses, injuries or conditions (Workers' Compensation, insurance companies, prisons, attorneys, welfare), or are you scheduled to see anyone else? ❑ YES (If "YES," complete information below.) NO 54 , fir NAME vc,gerawrnabak , as STREET ADRESS FIRST VISIT CITY STATE ZIP LAST SEEN PHONE NEXT APPOINTMENT A,.a Code MOM Number CLAIM NUMBER (If any) r`. REASONS FOR.VISITS If you need more space, use Remarks, Section 9. FORM SSA-3368-8K (11-2001) EF (11-2001) The 12-1998 edition may be used until exhausted PAGE ems SECTION9 - MEDICATIONS Do you currently take any medications for your illnesses, injuries or conditions? IR yEs If "YES," please tell us the following: (Look at ypur medicine bottles, if necessary.) O NO )"t a k" ci11.4i i�ftsi{ .4 r R ahu�% mo4+4,w Pr Denham Pan thdi s5 If you need more space, use Remarks, Section 9. t " SECTION 6 -TESTS Have you had, or will you have, any medical tests for illnesses, injuries or conditions? ❑ YES Ei NO If "YES," please tell us the following: (Give approximate dates, if necessary.) lgitfSx fx �� s ,*,¢f i M. "y"' t 'fit x:.'t k a4: 5t , n,'5"L,tP t'' r.s,Vg AP'�� 1 % t +"C"1x EYA �T d t t .'ice + ^ Th ''-r 1 ��,t'i �:1� +mCr� tK M .nk E fl� I 5th. i BIOPSY—Name of body part • . -Iwzwi,"W. SS l It *0#40 EEG 1SKJ11N Wild TPFaa'f: u • LIIX TEST. . tyri r: a X-RAY—Name of body part MRI/CT SCAN Name of body part If you have had other tests, list them in Remarks, Section 9. FORM SSA-3368-BK (11-2001) EF (11-2001) The 12-1998 edition may be used until exhausted PAGE 7 SECTION 7-EDUCATION/TRAINING INFORMATION . CY "t the highest grade of school completed. rade school: College: 1 2 3 4 5 6 .7 8 9 TO 11 12 GED 1 2 3 4 or more pproximate date completed: /95/ . Did you attend special education classes? ❑ YES '1NO (If 'NO,'go to part C) NAME OF SCHOOL ADDRESS (Number, Street, Apt. No.(if any), P.O. Box or Rural Route) City State Zip DATES ATTENDED TO TYPE OF PROGRAM . Have you completed any type of special job training, trade or vocational school? ❑ YES cycsNO If "YES," what type? Approximate date completed: SECTION 8 - VOCATIONAL REHABIUTATION, EMPLOYMENT, or OTHER SUPPORT SERVICES INFORMATION re you participating in the Ticket Program or another program of vocational rehabilitation :rvices, employment services or other support services to help you go to work? ] YES (Complete the information below) 5 NO NAME OF ORGANIZATION NAME OF COUNSELOR ADDRESS (Number, Street, Apt. No.(if any), P.O. Box or Rural Route) • City State Zip DAYTIME PHONE NUMBER • Area Code Number DaTES SEEN TO TYPE OF SERVICES OR TESTS PERFORMED (IC. vision, physicals, hearing, workshops, etc.) , RM SSA-3368-8K (11-2001) EF (11-2001) The 12-1998 edition may be used until exhausted PAGE 8 SECTION 9 - REMARKS 47"Theilel4brzr, -20,AsPfais ;nst fuee CP. ages 203 - 9'40/- 3303- flfedi ca ion Was nut cent-ethyl?, n . _Thserfad /ndh-onlc > fump. J)r tTh ledvpe hear? 2?saBroadaa/ jeccl der ei 7o3oy 3 di - 413O1b0 - C.vYI 1s' N- digits rneeljectdh pin uyn�o. - #Lsi did t n /- h) n t -H shvt �Q(1,ldok, Th wr - 144f is Basema 20ulde)" CO Pasa 303 -49+ -0636- Filson mid i0cf- 949 r .Cafe- ,¢t 9& was in .Roccldtk Mawr 4r tykai . akso hatin gm/ Miffs , °r egded - set Ac ached ANYONE MAKING A FALSE STATEMENT OR REPRESENTATION OF A MATERIAL FACT FOR USE IN DETERMINING A RIGHT TO PAYMENT UNDER THE SOCIAL SECURITY ACT COMMITS A CRIME PUNISHABLE UNDER FEDERAL LAW. Signature of claimant or person filing on claimant's behalf (parent, guardian) Data (Month, day, year) ��O pet "�Q�� Witnesses are required ONLY if this statement has been signed by mark (X) above. If signed by mark (X), two witnesses to the signing who know the person making the statement must sign below, giving their full addresses. 1. Signature of Witness 2. Signature of Witness Alava (Number and street, city, state,and ZIP code) Address weather and sneer,dry,stare.and ZIP codel :ORM SSA-3368-8K (11-2001) EF (11-2001) The 12-1998 edition may be used until exhausted PAGE 10 Form Approved SOCIAL SECURITY ADMINISTRATION 0M8 No. 0960-0598 WORK ACTIVITY REPORT (Self-Employed Person) Name of disabled person j Blind Social Security Number Sthlichfe.nmaycr- • j Not Blind • CYD' _.� 524-48-1115 Name of W/E (If other than disabled person) Social Security Number • PAPERWORK/PRIVACY ACT NOTICE The information requested on this form is authorized by Section 223 and Section 1632 of the Social Security Act. The information provided will be used in making a decision on your.claim. While completion of this form is voluntary, failure to provide all or part of the requested information could prevent an accurate and timely decision On your Clain and Could result in the loss of benefits. Information you furnish on this form may be disclosed by the Social Security Administration to another person or governmental agency only with respect to Social Security programs and to comply with Federal law requiring the exchange of inhumation between Social Security and another agency. we may also use the information you give us when we match records by computer. Matching programs compare our records with those of Other Federal,State or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government.- The law allows us to do this even if you do not agree to it. Explanations about these and other reasons wny information you provide us may be used or given out are available in Social Security Offices. It you want to learn more about this,contact any Social Security Office. PAPERWORK REDUCTION ACT: This information collection meets the clearance requirements of 44 U.S.C. 53507, as amended by Section 2 of the Paperwork Reduction Act ut 1995. You are not required to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take you about 30 minutes to read the instructions,gather the necessary facts,and answer the questions. Please use this form to describe your work activity since (Date disability 1 . Date (to be entered by SSA) began or, if later, date of prior investigation) - 01-01-2000 ANSWER EACH QUESTION AS FULLY AS POSSIBLE A. List name and address of business (include zip code) Lrs G-la.5S V- Nome =rn .m proveent.rn e, SD 2. '2100 tri tl. S Co ��03/4., B. Please Check if C. Briefly indicate the primar{y product or service .^ ❑ Farm ® Non-Farm!Fail Sarvice iacs sit", Ce X,egyaino) A. Describe the business in terms of arrangement and /or ow!5ership (Check one lCorp.,x n Sole Owner 0 Partnership (i' Farm Tenant n Farm Landlord B. Give your monthly self-employment income since the above date (average if not sure) Month' Year Gross Net Moth, Year Gross Net' Month s Year Gross Net 3. t&&A 'oat,d a6 f ► eap/o ve e. y t& eo�aorahi'o4. Month. Y er ,Gross Net •Mon Year Gr s Net • Month Year Gross Net C. List any months in which you earned more than , 4j rtMJ a. ;rat till 1.4.-k es. $200.00 or worked more than 40 hours in your �-�•• �J(/� dr business since the date shown in item 1. f jsj f ir 'nit, b f t/rJIls A. Describe (briefly) what you did in the business in terms of management ecisions, responsibilities, hours, production and..services before your illness or injury. ,p/ofriedid QQ�r�-s ,C,Ly — 41 Q /PG �sadr/e- - fd 0../I biu4atmn t xe- • 4 dhd�m , Die.' low>- lie.,./ lit r— �tts/a'� LhWp work• B. Was this business your sole livelihood prior to your illness or injury? - jg YES 0 NO Please describe your present work activities and any changes in your business because of your illness or injury. Explain such things as reduced hours of business, lower volume, fewer acres under cultivation or other. (if you use extra help, write "extra help" here and provide the details with you get to item 9;. pr�eS dm 2- W a.9 lass a b I L lv cep a- wi th p i t a.d'i m .199'7 r`3. h1 Aicei7ion r was IA 'ta-biIG i, e.sttcan 'hue . i V h&t-5 bnn .✓m — Do-(did) you make management decisions after your illness or injury? YES NO ()f "yes," describe the kinds of decisions made, the time spent making them and any c an es that eve taken place).So -t-ht morn S Z' (pot till ,� � man S�"�� on C. their Jobs . �on2t± nits ..L s-,-a. e.d Ie. kit-5Q Q-1 1y y w 1— a wh) b wt / bx�k home . A. If you began your business after you were injured or became ill, did you receive any special assistance from an agency or other source in setting up your business? ❑ YES ® NO B. Does this assistance continue or have additional special services been supplied? 0 YES KNO 7. (If "yes," please describe) A. What is the value of any normal business expense which you do (did) not pay including that which is furnished or paid for by another person or organization (such as free space or utilities)? Why were such items supplied to you for free and by whom were they furnished 1\0 8.a Describe any special expenses related to your illness or injury that you paid which are necessary for you to work (for example, attendant care, medical devices, equipment, prostheses, or similar items or services). • \....k\it. • • DESCRIBE ANY ADDITIONAL HELP YOU NEED(NEEDED)IN PERFORMING YOUR USUAL DUTIES BECAUSE OF YOUR ILLNESS OR INJURY. A. Number of assistants 221 B. Tim they devoted��g you C. What do (did) theyjg? D. Areiwere assistants j ec( one) E. IPpaid, how Cmcuucch? f?T_ _Ith j®J, mt LJ PAID UNPAID YJ�7�p�+�a(!/�do n !�j th .L F. Is (are) assistant(s) r ; :d to y 7 heckone) G. If yes, wh t is the refJ��tio u�r f email-, Sent h& IN YES i NO .Son 1441. in ,,` H. Why was the additional help needed?r Inca A. �r " '„ n a'nk Its V- ad uI24W4- Vt, s. Walk. Attar my .e s7S �,c a ,% .r had an e-lec?ric. s teeter the hint d me with• 1 *iso had 'iv war a, bar4< lara -.- Form SSA-82044 (2-1991) EF (12-2001) 2 If you need more space for any answer,use Page 3. think will be helpful. Please er to the previous questions by numberch as 4A or 48 or 5. 10, • If more space is needed, use an extra sheet. A. Check the appropriate block below: ZI am not receiving Social Security disability benefits and.%or supplemental security income (SS1) 1 1 . n I am receiving Social Security disability benefits and/or sup plemental security income (SSI) and I understand that the information provided above may result in my benefits being stopped. I have been given clam.the opportunity to submit any evidence I wanted and to make any statements concerning my PLEASE READ THE FOLLOWING STATEMENT. THEN SIGN, DATE AND PROVIDE ADDRESS AND TELEPHONE NUMBER. Knowing that anyone who makes a false statement or misrepresentation of a material fact for use in determining a right to payment under the Social Security Act commits a crime punishable under Federal law, I affirm that the answers to questions on this form are true. Sig ature of claimant/b eficiary or representative Date • Mail g address (Number and Street, Apt. no., P. . Box, or Rural Route.) TELEPHONE (Include area r.50 9'0 WC- 1 code) I 3a3- to-3c1? State 'County Zip Code E-ri eo l LVe4 d itC/� Form SSA-820•F4 (2-1991) EF (12-2001) 3 • • Boulder Community Hospital Boulder, Colorado 80001 and- b Sud/ery SCSI.IL737lAOWln&, LOYD 25001231 26-93-47 Lit[: 07/09/97 Room #: 2212 DIS: DOB: 10/16/30 88#: 524-48-1115 CARRIER #1: KAISHR INPATIENT POLICY #: 004481115 GRP #: 375301710 DATE OF OPERATION: 07/09/97 SURGEON: wrca.rav J WILLIAMS, ItO ASSI:STAPT: - STEPHEN RADA., MD AWNS $BIN: - General endotracheal/TROABS mss, ED PREOPERATIVE DIJUM OSIS(ES) : Left sciatica, left L4 and L5 radiculapathy, pswgdarthzosis, L3-L5 fusion. POSTOPERATIVE DIAGNOSIS(ES) : Left sciatica, left L4 and L5 radiculopathy, peeudarthroeis, L3-L5 fusion. OPERATIVE PROCSDU2E: PARTIAL CORP:=LIITCULECIIMCf L4 CS THE LEFT: WITH POSTERIOR LUMBAR INTIGUMADT FUSION L4-5; TAnn-DONS PSSODARTEROSIS MITE RE-DO PCSTTROLATERAL FOSIOA L3-4 AND L4-5 WITH ELECTRICAL STIMULATOR AND LEFT ILIAC BONS GRAFT. INDICATIONS: The patient is a 56-year-old gentleman who fell 20 feet from a scaffolding onto concrete on October 3, 1996, sustaining a severs L4 binat fracture occlvdiag the spinal canal, in addition to bilateral pilau fractures of the ankles. He had a posterior spinal reduction and fusion at L3-L5 with mild residual cauda equine syndrome. He had weakness of the foot and ankle dorsifleomrm on the left side frog the start, but in the last four months be has had worsening of the left sciatic pain, primarily at L4 and L5 dermatomss. Ankle and toe dorsitlexima remained weak on the left side. His spacial studies shaved bone fragments near the L4-5 foramina as well as some bulging of the L4-5 discos the left side. Peeudarthrosis was suspected due to thready bone formation and on the recent flexion and extension film, fracture of the left L5 pedicle screw. Repeat surgery was elected. Dgna.IPTION OF OPERATICS: >mdar adequate general endotracheal anesthesia, the patient was turned prone on the Andrews spinal table. All bony prominences were padded. Shoulders and elbows were flexed less than 90 degrees. Preoperative Ancef was given. a Sibley catheter was placed and spinal cord monitoring using HAE) potential was utilised. The lumbar region was prepped and draped in sterile fashion using an Ioban adhesive drape over the skin. His previous incision, 6 inches in length, was opened. The subcutaneous layer was sharply divided. Bleeding was controlled with electrocautery. The deep fascia was divided with the electrocautery knife and the spiaous process of L3 outlined above and L5 below. The lumbodorsal fascia and muscles were elevated subperiwreally out over the previous laminectasy and fusion site as �i well as out over the animus process and lamina of L3 above and L5 below. The try¢sroveae connector was then identified and removed. The Isola rod was rr^t� d from the left side as well as the interpedicular slotted connectors. Th. fracture screw at L5 on the left was removed. The screw above and the commens assamm Page 1 of 3 Copy for DAVID HADI03NESS, ND, Boulder Kaiser Permanents • Boulder Cammwdq/ SspiS Sadder. Colorado 80007 8CHLICEEEMMYhh6h, LDYD 35001.331 26-93-47 iat. 07/09/97 - Boom 9: 3313 DIE: scream on the right side appeared stable and were left alone. He had a dense, fibrous union of his bone graft in both lateral gutters. Interestingly, the origivial cancellous bone had turned to dense scar rather than bone. Pseudarthrosis was apparent primarily at L4-5 but also at Ica-4. The posterolataral fibrous tissue vas removed with rongeurs. The transverse processes L3-L5 were freshened with the Anspach bilaterally for re-do of his posterolateral fusion. Seat the transverse process was followed to the pedicle of L4 on the left, and using rongeura and the high-speed bur, the pedicle of L4 was removed. There appeared to be significant pressure on the left TA nerve root between the pedicle and a wall of hams. There was also some pressure from the L4-5 disc pushing up on L4 frouo 'below. A complete pediculectoay was done. There was still some prominence of retropulsed bone from his L4 burst fracture. The nerve root and dura were retracted medially and thin the high- spsed bur used to do a limited corpectomy of the upper left side body of L4, raving prominent boas so that the L4 and L5 nerve roots would have a flat bed in which to rest. Epidural bleeders were controlled with the bipolar cautery. The foramina was opened with Kern son rongeurs all the way l;*eually more than 1 cm lateral to the extent of the pedicle. Sic, the L5 nerve root was tracked distally. The pedicle screw was not impinging on the nerve root. Impingement of L5 appeared to be at the 14 body. We could pass a 4-mm gallbladder probe out along with the L5 nerve root as well as along L4 and L3 once the decompression was completed. Eaat, a diskectamy at L4-5 was done. The end plates were decorticated using ring and angled curets as well as the 3cralled 10-am and then 11-mm PISS cutters. Disc fragments were removed with pituitary rongeurs.Attention was was then directed to harvesting the bone graft. The same skin incision and a separate fascial and skin incision was utilized over the left posterior-superior iliac crest. The cautery knife was used to divide the soft tissues. Then the gluteal muscle attachments were elevated subperiosteally from the posterior crest. We harvested two fl-mm width, 5-a bloats of half the width of the iliac crest to use for structural grafts and then abundant corticoancellous bons from the posterior ilium. The woumd was irrigated with antibiotic irrigation. Colima was placed. A suction drain was placed, and the wound vas closed with a running 1-Vicryl suture. The bone graft was packed into the inner space, and first cancellous, and then the structural grafts, placing than flat and then rotating to distract to the disc space place anteriorly. The ►ena1nim g space was filled with bone. The bone graft appeared to be very stable and was flushed posteriorly without nerve root ingem..« Seat, the pedicle screw was placed at L4 on the left. Ae opted not to place. the screw at L4 on the right. The screw was redone at L5 on the left as the retained portion of screw appeared to pose no problem and would have been very difficult to remove. The new screw was first placed above, but this did no have good purchase, so a new 5.5-mm diameter and 35-rem length titanium s v was placed just lateral in the pedicle to the first screw and angling iL .riorly. We could demonstrate that this screw ass s away from the L5 nerve Page 3 of 3 Copy for DAVID BBEIMBEas, MD, Boulder Kaiser Permanents - ',-e .-. -..� • Balder Common* HosPaid Boulder. Colorado 8001 Scffi.ICHAmarSB, LOYD 25001231 26-93-47 A17[: 07/09/97 Boos 3: 2212 DIS: root and there was no change on our nerve root monitoring system. The L4 pedicle screw was angled inferiorly, with good purchase in bone. The position of the screws was monitored with lateral x-rays. Sext, the bone grafting was done laterally using the best cancellous bons between the transverse processes of L3, L4, and L5, followed by the BEI electrical stimulator, followed by lamina, bone, and corticocancellous stripe on the top, first on the left and then on the right lateral gutters. A new Isola rod was cut and bent and placed on the 3 slotted connectors with the middle screw using an angled washer. The nuts were tightened down on the slotted connectors for a. rigid fixation on the left side._ The transverse erection dewica was moved distally on the right, reconnected on the left and then a new transverse connector rigidly applied to fora a very rigid construct. After a final irrigation, the battery was tucked deep to the superficial facial layer. We made sure that the electrical stimulator wires did not touch the hardware. They were close, near the L3 and L5 pedicle screws. A suction drain was placed in the main incision. Closure was then done using running 1-Vicryl sutures in the deep fascia, running 0-Vicryl suture in the deep layer of superficial fascia, followed by e}*-aticular 3-0 Prolene, Vi-Drape spray and Steri-Strips. The dressing was X. lorm, sterile gauze, and a Reston foam dressing. The patient was then turned supine on his hospital bed, awakened, combated, and taken to the poet-anesthesia cars unit in satisfactory condition. The estinuted blood loss was 1200 cc. Fluid replacement was 1 liter of Hspan, 4 liters of crystalloid, and 675,cc of Call-Sever blood. There were 2 suction drains. The sponge and needle counts were correct. There are no complications. WILLIAM :7. WILLIAMS, MD I authorise my typed name to signify that I authenticated this report using my personal and confidential number. WW:cjt D: 07/09/97 T: 07/10/97 cc: DAVID ID ESISMOss, BD, Boulder 'raiser Permanents csmet SSwl REDOES Page 3 of 3 Copy for DAVID HAD SS, MD, Boulder Kaiser Panes ,�., �. to BOULDER MEDICAL CENTER,P.C. OFFICE PROCEDURE DATE: 03/05/2002 PATIENT: SCHLICHENMAYER,LOYD MEDICAL RECORD#: 00000-56-08-36 PREPROCEDURAL DIAGNOSES: 1. Post laminectomy infusion. 2. Axial pain and bilateral lumbar radiculopathy. POSTPROCEDURAL DIAGNOSES: 1. Post laminectomy infusion. 2. Axial pain and bilateral lumbar radiculopathy. PROCEDURE PERFORMED: Fluoroscopically guided intrathecal morphine test dose. REFERRING PHYSICIAN: Dr.Abrams,Kaiser. SURGEON: Melody Denham,M.D. ANESTHESIA: Intravenous sedation with Versed 2 mg. INDICATIONS: The patient is a very pleasant 63-year-old gentleman who has had severe back and leg pain since 1996. He has undergone previous fusion but unfortunately continues to have very severe pain. He states that his pain is severe with any movement and is somewhat improved by sitting. He has undergone treatments with physical therapy, anti-inflainmatories,and anti-seizure medications,as well as narcotic analgesics. However,his pain level continues to be at approximately eight out of ten in severity on average. The pain is again most severe in his lower.back with radiation into predominantly the left leg. He is here today for an intrathecal morphine test dose. If today's test trial is successful, then he would be a candidate for intrathecal morphine pump placement PROCEDURE: The patient was placed in the prone position. His back was prepped and draped in the usual sterile fashion. The skin was localized over the L2-L3 interspace with 1 cc of 1%lidocaine. A 25-gauge spinal needle was then introduced to the intrathecal space. Isovue 300 demonstrated presence in the spinal canal on both the P/A and lateral view. Medication given included preservative-free morphine 1 mg. The patient was then taken to the recovery room. Thirty minutes following his stay in recovery, he did report minimal pain and was awake and alert. He was instructed to record his pain level ever thirty minutes over the next twelve hours to determine whether or not he has a successful trial. If in fact he has good pain relief with minimal side effects then,again as mentioned,he would be a candidate for an intrathecal morphine pump. OFFICE PROCEDURE DATE: 03/05✓2002 PATIENT: SCHLICHENMAYER,LOYD MEDICAL RECORD#: 00000-56-08-36 2 (RE: SCHLICHENMAYER,LOYD) Melody Denham,M.D. sib DT: 03/06/2002 #125250 Pt#00000-56-08-36 cc: *Ambulatory Surgery Unit *Dr.Abrams,Kaiser Boulder,2525 13th Street,Boulder,CO 80304 r • CS OTIS, CORN & STEWART, LLC • Attorneys And Counselors At Law Fred L Otis flotistikcvlaw.com Weld County Planning Department GREELEY OFFICE September 3, 2003 SEP 0 3 2003 HAND DELIVER RECEIVED Mr. Kim Ogle Planner III _ 'Weld County Planning Department — 1555 North 17th Avenue Greeley, CO 80631 RE: Loyd and Sheila Schlichenmayer VI-0300134, Part of SW4SW4 of Section 6, TIN, R68W of 6th P.M., Weld County, Colorado Dear Mr. Ogle: Attached are copies of letters from the immediately surrounding property owners in support of my September 2, 2003, letter to you regarding the Schlichenmayer property: (1)Joe & Jean Baldwin, (2) Chuck& Tina Conilogue, and (3)Donald E. Iarussi, Jr. Sincerely, Fred L. Otis FLO:mas Enclosures xc: Mr. Bruce Barker Weld County Attorney Ms. Peggy Gregory , Building Compliance Officer ,, - Weld County Building Inspection Mr. and Mrs. Loyd Schlichenmayer The Doyle Building, 1812 56th Avenue,Greeley,Colorado 80634 Telephone: 970-330-6700 Fax: 970-330-2969 Metro: 303-659-7576 09/02/2003 14:04 303665753z LTS n agg PAGE 02 • Joe and Jean Baldwin 5050 County Line Road Erie, CO 80516 September 1, 2003 To Whom It May Concern: .' We are neighbors of Loyd and Sheila Schlich_enmayer, their son, Tracy and his family, and Tammy and her son. We have no concerns about any of them or objections to their homes. They are kind and considerate people, have greatly improved the appearance of our neighborhood and have proven to me to be very good neighbors! Sincerely, ojetet s-7 `eager‘ . Joe and Jean Baldwin 09/02/2003 14:04 3036657532 LTS GLASS PAGE 03 • September 1, 2003 To: Weld County To Whom it May Concern: This letter is in reference to our neighbor's at 5090 Weld County Rd_ 1,Erie,Co 80516, also referred to from here on out as The Schlichenmayer's. We have recently found out that The Schlicfieinnayer's are having problems with Weld County and their children living on the premises. We are aware that The Schlichenmayer's Children and their Families live there also, and have no dispute with them being there. r'^ The Schlichenmayer's are good neighbors and work very hard for what they have. We also feel if they were asked to move that The Schlichenmayer's would not be able to take care of the premises on there own, and if they were to move that whom ever purchased it would rent the building out as "Apartments"and we would NOT like that. We believe FAMILY COMES FIRST and that The Schlichenmayer's are doing everything-to help their Dad and Momrhave a comfortable home and help maintain the premises. If you have any questions please contact us at 303-828-3048. Sincerely, teiCea t tab„ Chuck&Tina Conilogue 5080 WCR#1 Erie,CO 80516 303-828-3048 .. a 09/02/2003 14:04 30366575b,. LTS GLASS PAGE 04 • Donald E. lanai,Jr. 5052 WCR 1 Erie,Colorado 80516 Home Phone (303) 828-2549 September 2,2003 Loyd and Sheila Scbli hee mater 5090 WCR 1 Erie,Colorado 80516 RE:Questions regarding family living in separate quarters on propeny.ffi 5090 WCR 1,Erie,Colorado. To Whom It May Concern: In regards to the property located at 5090 WCR 1,Erie,Colorado 80516. We,the owners of the property at 5052 WCR 1,Erie,Colorado 80516,have no concerns or reason to feel that the owner of the property at 5090 WCR 1,Erie, Colorado are in any way a burden on the fellow neighbors or that they are creating a negative visual impact. It is our feeling that they have platy of area surrounding the property and are neighbors who support positive values(IE— ' ' Family values,Proper care for property,Property improvements,Respect of fellow Neighbors,etc.). Our small community of homes with a common,private exit onto WCR 1 is by no means overbuilt or overcrowded. With regard to keeping the fancily together and allowing the residence to continue to exist as is,we are writing this letter in support of their arrangement. Oar families have come to know Loyd and Sheila Schiicbemrayer,Tracy Schlichenmayer and ha family and Tammy Schlichemnayer and her son. It is ow hope that this matter can be resolved quickly and simply for all concerned and that the city/county will grant the necessary permit to allow all to continue living as they have been on the property at 5090 WCR 1. Please feel free to call if any questions or comments need clarification. We are lPPy to help. ly, E.larassi,Jr. Hello