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DEPARTMENT OF PLANNING SERVICES
1555 N. 17th Avenue, Greeley, CO 80631
Phone (970) 353-6100, Ext. 3540, Fax (970)304-6498
USE BY SPECIAL REVIEW APPLICATION
Application Fee Paid /700 Receipt# U a c, Date c z 5 a/
Recording Fee Paid Receipt# Date
Application Reviewed by: St-
TO BE COMPLETED BY APPLICANT: (Please print or type, except for necessary signature)
LEGAL DESCRIPTION OF SPECIAL REVIEW PERMIT AREA:
tia S E4 3 :2- 3-60,5
PARCEL NUMBER: / 2 13 :52 O O 0 6 2 t (12 digit number-found on Tax LD.
Information or obtained at the Assessor's Office.
Section 32 , T 3 N, R &5 W-Total Acreage 39,5 Zone District :3 Overlay Zone
Property Address (if available) /2q g F' UJ c fZ 41 Ft/Ltd-So tJ C o . 8C 6 1-
Proposed Use Au rot-rK-44:KPRreZ',cs✓1i,ws R c)c-!1V _)44:1-0S4b S.-f'4I/0T3s1� I-
SURFACE FEE (PROPERTY OWNERS) OF AREA PROPOSED FOR THE SPECIAL REVIEW
PERMIT
Name:`1eFtiJ HOGHPitAG,GM Address: 116 4o Gtoaa
City/State/Zip: � 3) � )
Cit
y p: Eladso& a.ftoby2 Home Telephone:S-a6 <7&' 5 Business Telephone S 4 R
Name: Address:
City/State/Zip: Home Telephone: Business Telephone
APPLICANT OR AUTHORIZED AGENT(if different than above)
Name: 6o n-x- :E H, Ito Gy. r45
Address: 3 ?' 4- C, 1 t LJ c r City/State/Zip: U� C 0
Home Telephone(?a3 ).3ta--0 17 $ Business Telephone(3bB7777 -
DEPARTMENT OF PLANNING SERVICES USE ONLY
Case#
Floodplain: ❑ Yes T} No Geologic Hazard: o Yes gs<No
I hereby state that all statements and plans submitted with the application are true and correct to the best of
my knowledge.
Rev: 1-27-97 Si ure: Ownerer o or AuthorizedAgent
EXHIBIT
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Road File#
RE:
Other Case No.
APPENDIX B
WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Public Works Department
1111 II Street,P.O.Box 758, Greeley, CO 80632 Date:
Phone: (970)356-4000,Ext. 3750 Fax: (970)304-6497
1. Applicant Name AL t{?) Hp C H j1 t k C 9E' PhoneC3n3)536,--9 e6,5-
Address I c?64 cl U.-it t g,$ City l4c-t d Statec& Zip ?C> 6 tr.
2. Address or location of access j 2'/$$ W G rc 4 / N tt,4 5 p oti c o . `C& ' 2
Section --.9`C Township 3 Range A T
Subdivision Block Lot
Weld County Road # 4 I Side of Road/ w Distance from nearest intersection /%2 al%A- it:-
3. Is there an existing access to the property? Yes V No #of accesses
4. Proposed Use:
Permanent O Residential/Agricultural 124, Industrial
❑ Temporary ❑ Subdivision ❑ Commercial O Other
5. Site Sketch
Legend for Access Description: I I L
AG= Agricultural gt.
RES = Residential •
-O&G= Oil&Gas
R. = Ditch Road 11
D = House
O = Shed C c p
11-1 �w
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OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date - Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
O Installation authorized ❑ Information Insufficient
Reviewed By:
Title:
in:wpfiles\engineer\access
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