HomeMy WebLinkAbout20011261.tiff RESOLUTION
2a). RE: ACTION OF THE BOARD CONCERNING MOBILE HOME PERMIT, ZPMH #2256 -
MARY ANN PLONKA
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board of County Commissioners of Weld County, Colorado, on the 14th
day of May, 2001, considered the request of Mary Ann Plonka, 16230 Highway 52, Fort Lupton,
Colorado 80621, for a mobile home to be used as an Accessory to the Farm on a parcel of land
being more particularly described as follows:
Part of the SW 1/4 of Section 2, Township 1 North,
Range 66 West of the 6th P.M., Weld County,
Colorado
WHEREAS, the Board of County Commissioners, having heard all of the testimony,
finds that said request for a mobile home to be used as an Accessory to the Farm does not fully
comply with the Weld County Code and should be denied for the following reasons:
1. Section 23-4-170.A.1 —The mobile home will not be occupied by persons
principally employed at or principally engaged in the operation of the Use where
the mobile home is located.
2. Section 23-4-170.A.2 —The mobile home is not necessary for the effective and
economic operation of the use and/or protection of the agricultural use.
3. Section 23-4-170.A.3 —The mobile home may by used as an income source by
the applicant for rental to persons who are not principally employed upon the lot.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the request of Mary Ann Plonka for permission to place a mobile
home to be used as an accessory to the farm on the above described parcel of land, which was
found not to be in compliance with Article IV, Division 3, Chapter 23 of the Weld County Code,
be, and hereby is, denied for the above stated reasons.
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2858072 06/15/2001 04:06P JA Suki Tsukamoto
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2001-1261
pc , PLC App ) PL1467
ZPMH #2256 - MARY ANN PLONKA
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 14th day of May, A.D., 2001.
BOARD OF COUNTY COMMISSIONERS
#010.'+3/44r WELD CO NTY, COLORADO
/`ti l . /
ATTEST: , ' ` / d
v,.
J Gene, Chair
Weld County Clerk to the = :r. ( %W
`r CUSED DATE OF SIGNING (AYE)
_...\s lenn Vaad, Pro-Tem
BY: Yeti/AA , 1:n7 ( !
Deputy Clerk to the Board
Willi . Jerke
RO D AS FORM:
D id ng
unty Attorney
Robert D. Masden
1111111111111111111 III IIIII 1111111 1IIII III I1III IIII IIII
2858072 06/15/2001 04:06P JA Suki Tsukamoto
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2001-1261
PL1467
4arl MOBILE HOME ZONING PERMIT
yuleADMINISTRATIVE REVIEW
COLORADO
PLANNER: Wendi Inloes HEARING DATE: May 14, 2001
CASE NUMBER: ZPMH-2256
APPLICANT: Mary Ann Plonka
ADDRESS: 16230 Hwy 52, Fort Lupton, CO 80621
REQUEST: This is a request for a Mobile Home to be used for a Temporary Accessory to the
Farm Use.
LEGAL DESCRIPTION: Part of the SW4of Section 2, T1 N, R66W of the 6th P.M., Weld County,
Colorado
PARCEL NUMBER: 1471 02 000041
PARCEL SIZE: 35 acres ZONE DISTRICT: A(Agricultural)
WATER SOURCE: Individual well SEWER SOURCE: Septic system
The Department of Planning Services' staff has reviewed this request and recommends that this
request be denied for the following reasons:
1. It is the opinion of the Department of Planning Services' staff that the applicant has not shown
compliance with Section 23-4-170 of the Weld County Code.
a. The mobile home is necessary for the effective and economic operation of the use
and/or protection of the agricultural use.
The Department of Planning Services has determined that there is not enough justification
to warrant an additional mobile home on the site for farm use. The parcel size of thirty-five
(35) acres, is forty-five (45) acres less than the minimum lot size in the Agricultural zone
district. The site is currently dryland pasture,with no apparent crops,and a minimal number
of animal units. According to Chapter 22 of the Weld County Code,(Comprehensive Plan),
lots of less than 80 acres are not generally large enough to retain viable farming operations.
The question as to whether or not a parcel of this size can house two dwelling structures
is not under consideration. There are other options the applicant may seek to obtain this
objective. The applicant has failed to establish just cause for the issuance of this structure.
2001-126'1
Should the Board of County Commissioners approved this request,the Department of Planning Services'
staff recommends the following conditions be attached:
1. The applicant shall apply for a building permit for the mobile home prior to locating the mobile home
on the property.
2. Prior to the occupancy of the mobile home, the mobile home shall be connected to an approved
sewage system and a legal water supply.
3. The mobile home shall not be occupied until such time that the applicant has complied with
Conditions 1 and 2 stated above.
4. The mobile home will be occupied by persons principally employed at or principally engaged in the
operation of the use where the mobile home is located. Accessory farm use of the mobile home
shall be established and revalidated on an annual basis as follows: evidence shall be submitted
by the applicant or property owner by the first of each year for review and acceptance by the
Department of Planning Services verifying that the mobile home occupant is principally employed
at or engaged in the farming operation on the subject property. The evidence shall consist of tax
records,employment agreements or other documentation as determined suitable by the department
of planning services. Failure to submit the required documentation may result in cessation of the
allowance of the mobile home for temporary accessory farm use.
5. The mobile home will not be used as an income source by the applicant for rental to persons who
are not principally employed upon the lot.
6. A Weld County Septic Permit is required for the proposed home septic system and shall be installed
according to the Weld County Individual Sewage Disposal Regulations.
7. Prior to the release of building permits for the mobile home, the lot owners shall verify with the
nearest Town/City or Sanitation District to determine the location of the nearest sewer line. In
accordance with the Weld County Code, if a sewer line exists within 400 feet of the property and
the sewer provider is willing to serve the proposed structure, a septic permit cannot be granted by
the Weld County Department of Public Health and Environment.
8. Should noxious weeds exist on the property or become establishes as a result of the proposed
development, the applicant/landowner shall be responsible for controlling the noxious weeds.
9. The applicant shall maintain compliance with Section 23-4-170 of the Weld County Code at all
times.
DEPARTMENT OF PLANNING SERVICES
1555 N. 17th Avenue
Greeley, CO 80631
Phone (970) 353-6100, Ext. 3540
l(it URe
Fax (970) 304-6498
COLORADO
March 29, 2001
Mary Ann Plonka
"16230 Hwy 52
Ft. Lupton, CO 80621
Subject: ZPMH-2256 - Part of the SW4 of Section 2, Township 1 North, Range 66 West of the 6th P.M.,
Weld County, Colorado.
Dear Ms. Plonka:
Your zoning permit for a mobile home application is being processed by our office. If it is determined that
the application meets the approval criteria of Chapter 23, Article IV, Division 3, of the Weld County Code,
you will be notified that the zoning permit is approved. If the staff determines that the application does not
meet the approval criteria, you will be notified and asked to appear before the Board of County
Commissioners at a public hearing. You will be informed of the hearing date at least a week prior to the
hearing. The Board of County Commissioners will then consider your application and make a final decision
on the zoning permit for the mobile home.
It is the policy of Weld County to refer an application of this nature to any town or municipality lying within
three miles of the property in question or if the property under consideration is located within the
comprehensive planning area of a town or municipality. Therefore, our office has forwarded a copy of the
submitted materials to the Fort Lupton Planning Commission for their review and comments. It is
recommended that you and/or a representative be in attendance at the Fort Lupton Planning Commission
meeting to answer any questions the Commission members may have with respect to your application.
Please call the City of Fort Lupton at 970-346-0326, for further details regarding the date, time, and place
of this meeting.
If you have any questions concerning this matter, please feel free to call me.
Respectfully,
(
sp di
Wendi Inloes
Planning Technician II
DEPARTMENT OF PLANNING SERVICES
PHONE (970) 353-6100, EXT.3540
WI 1 FAX (970) 352-6312
C. WELD COUNTY ADMINISTRATIVE OFFICES
1400 N. 17TH AVENUE
GREELEY, COLORADO 80631
COLORADO
March 5, 1999
Mary Ann Plonka
16230 Highway 52
Fort Lupton, Colorado 80621
RE: Certificate of Compliance for an Accessory to Farm mobile home
Dear Ms. Plonka:
Thank you for your letter received March 4, 1999. The information you have provided is a great
help. The fencing, barn and arena repair, as well as harvest of rye and planting of grass all are
valid farm uses which may justify an Accessory to Farm mobile home.
Staffs concerns are based upon continued justification in the future. Staff has concerns that
once the repair and fencing is completed and the grass is planted, the mobile home will cease to
be justified as Accessory to Farm.
Section 43.2.3.1.1 of the Weld County Zoning Ordinance states: "The MOBILE HOME will be
occupied by persons principally employed at or engaged in the operation of the USE where the
MOBILE HOME is located. ACCESSORY farm USE of the mobile home shall be established
and revalidated on an annual basis as follows: Evidence shall be submitted by the applicant or
property owner by the first of each year for review and acceptance by the Department of
Planning Services verifying that the mobile home occupant(s) is principally employed at or
engaged in the farming operation on the subject property. The evidence shall consist of tax
records, employment agreements or other documentation as determined suitable by the
Department of Planning Services. Failure to submit the required documentation may result in
cessation of the allowance of the MOBILE HOME for TEMPORARY ACCESSORY Farm USE."
Your letter indicates that you can offer a "small salary", which indicates that the occupant of the
mobile home will need to be principally employed off the farm.
In accordance with Section 43.2.3.1.1 requires you to resubmit evidence every year to verify that
the occupant of the mobile home is principally employed on the farm. Section 43.2.3.4 also
states: "All MOBILE HOMES as ACCESSORY farm USES are TEMPORARY. Allowance of the
MOBILE HOME shall be extended only if the USE continues to be in conformance with the
criteria set out in Section 43.2.3.1.1. The MOBILE HOME shall be removed from the property
upon the cessation of the USE of the MOBILE HOME as an ACCESSORY farm USE or at any
such time as the MOBILE HOME is used for other than the allowed USE."
Letter to Mary Ann Plot*
Page 2
Unfortunately, based upon the information provided, staff has determined that an Accessory to
Farm mobile home is not justified. You will need to remove the mobile home from the property
within sixty (60) days.
If you wish to have the Weld County Board of Adjustment review this staff determination, I have
enclosed a copy of the appropriate procedural guide and application. This application requires a
$200.00 application fee. Should you accept the staff determination and remove the mobile
home from the property, please call me or submit a letter requesting a refund of your$50.00
Certificate of Compliance fee.
Please call me if you have any questions about either of these procedures.
Sincerely,
C, C>;4 Crjj
cs ott Ballstadt
Planner
cc: Monica Daniels-Mika, Director
Wendi Inloes, Planning Technician
c:\apps\misc\plonka
NOTICE
Pursuant to the zoning laws of the State of Colorado and Weld County Ordinances and
Resolutions, a public hearing will be held in the Chambers of the Board of County Commissioners
of Weld County, Colorado, Weld County Centennial Center, 915 10th Street, First Floor, Greeley,
Colorado, at the time specified.
If a court reporter is desired, please advise the Clerk to the Board, in writing, at least five
days prior of the hearing. The cost of engaging a court reporter shall be borne by the requesting
party. In accordance with the Americans with Disabilities Act, if special accommodations are
required in order for you to participate in this hearing, please contact the Clerk to the Board's Office
at (970) 356-4000, Extension 4226, prior to the day of the hearing.
The complete case file may be examined in the office of the Clerk to the Board of County
Commissioners,Weld County Centennial Center, 915 10th Street,Third Floor, Greeley, Colorado.
E-Mail messages sent to an individual Commissioner may not be included in the case file. To
ensure inclusion of your E-Mail correspondence into the case file, please send a copy to
chard ing@co.weld.co.us.
DATE: May 14, 2001
TIME: 9:00 a.m.
APPLICANT:
Mary Ann Plonka
16230 Highway 52
Fort Lupton, Colorado 80621
REQUEST: Zoning Permit for a Mobile Home#2256
LEGAL DESCRIPTION: Part of the SW 1/4 of Section 2,Township 1 North, Range 66 West of the
6th P.M., Weld County, Colorado
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
DATED: May 5, 2001
CERTIFICATE OF MAILING
The undersigned hereby certifies that a true and correct copy of the foregoing Notice of
Hearing, was placed in the United States mail, first class mail, postage prepaid, addressed to
the following property owners.
DATED this 5th day of May, 2001.
MARY ANN PLONKA GORDON AND LETA BOWEN
16230 HIGHWAY 52 16317 HIGHWAY 52
FORT LUPTON CO 80621 PO BOX 311
FORT LUPTON CO 80621
RONALD AND SHARON AUSTIN
16651 WELD COUNTY ROAD 12
FORT LUPTON CO 80621
DWAYNE BOWEN, CAROL BOWEN,
AND MELISSA FLORES-BOWEN
16267 WELD COUNTY ROAD 12
FORT LUPTON CO 80621 /
STEVEN HELVIG c / c��Q)da6G�
16586 HIGHWAY 52 Deputy Clerk to the Board
FORT LUPTON CO 80621
HIGHWAY 160 PARTNERSHIP
8791 CIRCLE DRIVE
WESTMINSTER CO 80030
GLENN AND MARYJO JESSER
16307 HIGHWAY 52
PO BOX 311
FORT LUPTON CO 80621
RICE FAMILY TRUST
C/O DALE AND THEORA RICE
1666 POWELL CREEK ROAD
WILLIAMS OR 97544
JAMES VAWTER
460 PRAIRIE RIDGE ROAD
HIGHLAND RANCH CO 80126
Wo monicy
--. EN tlaS c o
ZP40t.v
/ WELD COUNTY DEPARTMENT OF PLANNING SERVICES
1555 N. 17th Avenue, Greeley, Colorado 80631, Phone: (970) 353-6100, Ext. 3540, Fax: (970) 304-6498
MOBILE HOME ZONING PERMIT APPLICATION
'PORTANT- Co Mete all items on both pages Mark boxes where aoolicable
APPLICANT in , ar y Mn /) plc 4 )«t PHONE3 o3-gJ7_19 i
ADDRESS/CITY/STATE/ZIP CODE /(cUo/Jlyji way ocz rot"-/ojnron, Oc go .2/
OWNER Mari 19 nil Plop i -q PHONE303-b'57_Itin
ADDRESS/CITY/STATE/ZIP CODE/krz3d/711o1 copy S2- tO11LUpro, Cosoca,/ ,
CITY- STATE -ZIP rOPT 1-149 roe? 1 CO rD 1
L•
EGAL DESCRIPTION - Section , T N, R W. Total Acreage,
PARCEL IDENTIFICATION NUMBER _
STAFF REVIEW -Application Fee -$50.00 Weld County PIinning Dept.
Check type of application
o Temporary Use During Construction of a Residence (6 months) MAR 2 h 2001
❑ Temporary Storage (6 months)
n Accessory to the Farm (for first mobile home) RECEIVED
❑ Accessory Use in the C (Commercial)or I (Industrial)zone district(for first mobile home)
BOARD OF COUNTY COMMISSIONERS APPROVAL/ADMINISTRATIVE REVIEW
Application Fee -$230.00
Check type of application
❑ Use Beyond 18 months During Construction of a Residence
❑ Extension Beyond 6 months for Temporary Storage
❑ Accessory Structure used for a Storage Unit
❑ More than one MH as Accessory to Farm
❑ MH used as Accessory Use as an Office
❑ More than one MH as Accessory Use in C (Commercial)or I (Industrial) zone district
❑ Temporary Use during Medical Hardship
o Principal Dwelling
TYPE OF SEWAGE DISPOSAL TYPE OF WATER SUPPLY
❑ Public or private company 0 Public or private company:
% Septic Tank- Permit# A. Individual (well, cistern) Permit#
Copy attached: Yes 0 No 0 Copy attached: Yes 0 No 0
•
ACCESS: X Existing ❑ Proposed
What housing is available on the property and what is its present use?
How many mobile homes are on the property at the present time? 0
a /
Applic UOwners Signature - Date
is located.
2. Describe below, or attach a letter describing the farming occupation and duties associated
with the mobile home occupa at this site:
•
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3. I have attached a copy of the deed to this site. The entire property in which the accessory
to the farm mobile home is located is approximately_ -3.S acres.
My cignatura or this form verifies the:. i u.nd'. stand YnJ w t;:rnph. 3E. cf ^L.e abcve ntated
criteria for the mobile home located on my property.
/�
Print Name:,i/hir-1 /7r'1n ignature:yr//,y�7 / 217.1 e: 3 /9 B`.
�/° /1 ` .d& J a
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REFERRAL LIST
NAME: Mary Ann Plonka CASE NUMBER: ZPMH-2256
REFERRALS SENT: March 29,2001 REFERRALS TO BE RECEIVED BY:April 11,2001
COUNTY TOWNS and CITIES
_Attomey Ault
_X Health Department Brighton
Extension Service Broomfield
Emergency Management Office Dacono
Sheriffs Office Eaton
_X Public Works Erie
Housing Authority Evans
Airport Authority Firestone
Building Inspection _X_Fort Lupton
Code Enforcement Frederick
STATE Garden City
Division of Water Resources Gilcrest
Geological Survey Greeley
Department of Health Grover
Department of Transportation Hudson
Historical Society Johnstown
Water Conservation Board Keenesburg
Oil and Gas Conservation Commission Kersey
Division of Wildlife: LaSalle
West of 1-25(Loveland) Lochbuie
East of I-25 (Greeley) Longmont
Division of Minerals/Geology Mead
FIRE DISTRICTS Milliken
Ault F-1 New Raymer
Berthoud F-2 Northglenn
Briggsdale F-24 _Nunn
Brighton F-3 _Pierce
Eaton F-4 Platteville
_X_Fort Lupton F-5 Severance
Galeton F-6 Thornton
Hudson F-7 Windsor
Johnstown F-8
La Salle F-9
Mountain View F-10 COUNTIES
Milliken F-11 Adams
Nunn F-12 Boulder
Pawnee F-22 Larimer
Platteville F-13
Platte Valley F-14 FEDERAL GOVERNMENT AGENCIES
Poudre Valley F-15 US Army Corps of Engineers
Raymer F-2 USDA-APHIS Veterinary Service
Southeast Weld F-16 Federal Aviation Administration
Windsor/Severance F-17 Federal Communication Commission
Wiggins F-18
Union Colony F-20 SOIL CONSERVATION DISTRICTS
Brighton
OTHER Fort Collins
School District Greeley
Ditch Company Longmont
West Adams
COMMISSION/BOARD MEMBER
04/11/2001 08: 56 3038570351 CITY OF FORT LUPTON PAGE 01
Weld County Referral
illik March 29 2001
COLORADO
The Weld County Department of Planning Services has received the following Item for review:
Applicant Mary Ann Plonka Case Number ZPMH-2256
Please Reply By April 11,2001 Planner Wendi Inloe5
•
Project Zoning Permit for a Mobile Home used as a Temporary Accessory to the Farm
Legal Part of the SW4 of Section 2, Township 1 North, Range 66 West of the 6th P.M.,
Weld County, Colorado.
•
Location South of and adjacent to SH 52; approximately'A mile west of WCR 35
Parcel Number 1471 02 000041
The application is submitted to you for review and recommendation. Any comments or recommendation
you consider relevant to this request would be appreciated. Please reply by the above listed date so that
we may give full consideration to your recommendation. Any response not received before or on this date
may be deemed to be a positive response to the Department of Planning Services. If you have any further
questions regarding the application, please call the Planner associated with the request.
C)/We have reviewed the request and find that it does/does not comply with our Comprehensive Plan
Y We have reviewed the request and find no conflicts with our interests.
❑ See attached letter.
•
Comments:
•
•
•
Signature Y,� be,,, fL Date
Agency
tweld County Planning Dept. 01555 N. 17Th Ave.Greeley,CO. 80631 4(970)353-6100 ext3540 .(970)304-6498 fax
R`c 9 o)
Kitt Weld County Referral
March 29, 2001
IlligC.
COLORADO
The Weld County Department of Planning Services has received the following item for review:
Applicant Mary Ann Plonka Case Number ZPMH-2256
Please Reply By April 11, 2001 Planner Wendi Inloes
Project Zoning Permit for a Mobile Home used as a Temporary Accessory to the Farm
Legal Part of the SW4 of Section 2, Township 1 North, Range 66 West of the 6th P.M.,
Weld County, Colorado.
Location South of and adjacent to SH 52; approximately 1/2 mile west of WCR 35
Parcel Number 1471 02 000041
The application is submitted to you for review and recommendation. Any comments or recommendation
you consider relevant to this request would be appreciated. Please reply by the above listed date so that
we may give full consideration to your recommendation. Any response not received before or on this date
may be deemed to be a positive response to the Department of Planning Services. If you have any further
questions regarding the application, please call the Planner associated with the request.
❑ We have reviewed the request and find that it does/does not comply with our Comprehensive Plan
❑ We have reviewed the request and find no conflicts with our interests.
U See attached letter.
Comments:
Signature �� .6 � Date4-1)/0/G �� �W
Agency /7.7e 7- )(frit/ f7.Pdc L v'.
4Weld County Planning Dept. •:•1555 N. 17th Ave.Greeley,CO.80631 •:•(970)353-6100 ext.3540 ❖(970)304-6498 fax
itt\t:141‘4, Weld County Referral
March 29, 2001
WilDe RECEIVED
COLORADO APR 0 3 2001
WELD COUNTY
P1*140 WORK.DEPT
The Weld County Department of Planning Services has received the following item for review:
Applicant Mary Ann Plonka Case Number ZPMH-2256
Please Reply By April 11, 2001 ' Planner Wendi Inloes
Project Zoning Permit for a Mobile Home used as a Temporary Accessory to the Farm
Legal Part of the SW4 of Section 2, Township 1 North, Range 66 West of the 6th P.M.,
Weld County, Colorado.
Location South of and adjacent to SH 52; approximately 1/2 mile west of WCR 35
Parcel Number 1471 02 000041
The application is submitted to you for review and recommendation. Any comments or recommendation
you consider relevant to this request would be appreciated. Please reply by the above listed date so that
we may give full consideration to your recommendation. Any response not received before or on this date
may be deemed to be a positive response to the Department of Planning Services. If you have any further
questions regarding the application, please call the Planner associated with the request.
❑ We have reviewed the request and find that it does/does not comply with our Comprehensive Plan
O. We have reviewed the request and find no conflicts with our interests.
See attached letter.
Comments:
Signature !a-Mid Date 5 - 4, ,- (
Agency k<-(g. .-n-h-1 h `
+Weld County Planning Dept. +1555 N. 17th Ave.Greeley,CO.80631 +(970)353-6100 ext.3540 +(970)304-6498 fax
MEMORANDUM
' TO: Wendi Inloes, Planner Tech II DATE: April 9, 2001
FROM: Donald Carroll, or C. SUBJECT: ZPMH-2256,Engineering
Plonka
WeldtCoun ty Planning Dept.
COLORADO
RECEIVED
The Weld County Public Works Department has reviewed this proposal. This project fall primarily under the
purview of the Zoning Permit for Mobile Home Standards. Our comments and requirements are as follows:
REQUIREMENTS:
The Weld County Public Works Department recommends approval of this application.
The Colorado Department of Transportation (CDOT) has jurisdiction over all accesses to the State Highways.
Please contact Gloria Hice-Idler or Tess Jones at the Greeley office to verify the access permit or for any
additional requirements that may be needed to obtain or upgrade the permit.
Pursuant to Ordinance 169A, if noxious weeds exist on the property or become established as a result of the
proposed development, the applicant/landowner shall be responsible for controlling the noxious weeds.
pc: ZPMH-2256
plan18zpmh.wpd
Memorandum
� TO: Wendi Inloes, W.C. Planning
I
O DATE: April 10, 2001
COLORADO FROM: JPeden, EH Services
W CASE: ZMPH-2256
v Ct
APPLICANT: Plonka, Mary Ann
Environmental Health Services has reviewed this proposal; the following conditions are
recommended to be part of any approval:
1. A Weld County Septic Permit is required for the proposed home septic system
and shall be installed according to the Weld County Individual Sewage Disposal
Regulations.
2. Prior to the release of building permits for the mobile home, the lot owners shall
verify with the nearest Town/City or Sanitation District to determine the location
of the nearest sewer line. In accordance with the Weld County Code, if a sewer
line exists within 400 feet of the property and the sewer provider is willing to
serve the proposed structure, a septic permit cannot be granted by the Weld
County Department of Public Health and Environment.
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1
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WCR #_--
fusEPLEASE INDICATE IN FEET, THE DISTANCE FROM
• s
THE NEAREST WELD COUNTY ROAD INTERSECTIONv`
TO YOUR ACCESS OR DRIVEWAY.
u * � J . Please indicate number of feet to property
res#? _ N lines and also to center of roads if applicable.
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2574991 B-1633 P-495 10/21/1997 12:49P PG 1 OF 2 REC D0C t
, Weld County CO JA Suki Tsukamoto Clerk & Recorder 11 .00
). QUIT CLAIM DEED
J= '
',; ,,
:Y THIS DEED, Made this 2nd day of October , 1997 ,
°.`. between
Mary Ann Mount
.., of the - *County of Weld and State of
4':, Colorado, grantor(s), and
Mary Ann Plonka
whose legal address is 16230 Highway 52, Fort Lupton, Colorado,
80621 •
of the County of Weld and State of Colorado, grantee(s),
WIINESSETH,That the grantor(s), for and in consideration of the sum of
TEN AND OTHER GOOD AND VALUABLE CONSIDERATION DOLLARS
the receipt and sufficiency of which is hereby acknowledged,has remised,released,sold,conveyed and QUIT CLAIMED, and by
these presents do remise,release, sell,convey and QUIT CLAIM unto the grantee(s), her heirs, successors and assigns,
forever, all the right, title, interest, claim and demand which the grantor(s) ha s in and to the real property, together with
improvements,if any,situate,lying and being in the County of Weld and State of
Colorado,described as follows:
4-1 See attached "Exhibit A"
•
alsoknownbystreetandnumberas:16230 Highway 52, Fort Lupton, Colorado, 80621
'i TO HAVE AND TO HOLD the same, together with all and singular the appurtenances and privileges thereunto belonging or in
,;$1, anywise thereunto appertaining,and all the estate,right,title,interest and claim whatsoever,of the'grantor(s),either in law or equity,to
2f a„ the only proper use,benefit and behoof of the grantee(s), her heirs and assigns forever.
d; ' IN WITNESS WHEREOF,The grantor(s)has executed this deed on the date set forth above.
0
t
i
'17-4
STATE OF COLORADO, Iss.
County of CL ✓
�^ The foregoing Instrument was acknowledged before me this AID %l ,
g g B of day of j�cE�h� . ..
�: by 0 ,A. )'Ylotw.t 04,`.,
My commission expires - - O 3-/y—.go 0/ ,19 . Witness my hand and official seal. if O i e J , 4
aS 4
. J: I' Q, •
F L114',.k e) 10 1 2 Q ,7
Notary Publk • e,T
'If in!Denver, insert"City and."
tNo.933.Rev.3-85. QUIT CLAIM DEED Bradford Publishine,5825 w 6th Ave..Lakewood.CO 80214—0011 2336900 717CA
EXHIBIT A
• , 2574991 B-1633 P-495 10/21/1997 12:49P PG 2 OF 2
THAT PART OF THE SOUTHWEST QUARTER OF SECTION 2 , TOWNSHIP 1
NORTH, RANGE 66 WEST OF THE SIXTH PRINCIPAL MERIDIAN, BEING
MORE PARTICULARLY DESCRIBED AS FOLLOWS : BEGINNING AT THE
WEST QUARTER CORNER OF SAID SECTION 2 ; THENCE SOUTH 00
DEGREES 00 MINUTES 00 SECONDS EAST ON AN ASSUMED BEARING
ALONG THE WEST LINE OF SAID SOUTHWEST QUARTER A DISTANCE OF
50 . 00 FEET TO THE SOUTH RIGHT OF WAY LINE OF COLORADO STATE
HIGHWAY 52 (FEBRUARY 1990) ; THENCE NORTH 89 DEGREES 36
MINUTES 45 SECONDS EAST PARALLEL WITH THE NORTH LINE OF SAID
SOUTHWEST QUARTER AND ALONG SAID SOUTH RIGHT OF WAY LINE A
DISTANCE OF 1431 . 79 FEET TO A POINT 1192 . 00 FEET WEST OF THE
EAST LINE OF THE SOUTHWEST QUARTER OF SECTION 2 AND THE TRUE
POINT OF BEGINNING; THENCE CONTINUING NORTH 89 DEGREES 36
MINUTES 45 SECONDS EAST PARALLEL WITH SAID NORTH LINE OF THE
SOUTHWEST QUARTER A DISTANCE OF 1192 . 00 FEET TO A POINT ON
THE EAST LINE OF THE SOUTHWEST QUARTER OF SECTION 2 ; THENCE
SOUTH 00 DEGREES 20 MINUTES 10 SECONDS EAST ALONG SAID EAST
LINE OF THE SOUTHWEST QUARTER A DISTANCE OF 1280 . 60
FEET; THENCE SOUTH 89 DEGREES 40 MINUTES 36 SECONDS WEST A
DISTANCE OF 1192 . 00 FEET; THENCE NORTH 00 DEGREES 20 MINUTES
10 SECONDS WEST PARALLEL WITH SAID EAST LINE OF THE SOUTHWEST
' QUARTER OF SECTION 2 A DISTANCE OF 1279 . 26 FEET TO THE TRUE""
POINT OF BEGINNING, COUNTY OF WELD, STATE OF COLORADO.
LESS AND EXCEPT THE NORTH 25 FEET THEREOF FOR ADDITIONAL
HIGHWAY 52 RIGHT OF WAY;
TOGETHER WITH: A NON-EXCLUSIVE INGRESS AND EGRESS EASEMENT
OVER THE FOLLOWING DESCRIBED PARCEL, BEING FOR AN ADDITIONAL
ACCESS EASEMENT WEST OF THE EXISTING NORTH-SOUTH ACCESS
EASEMENT TO THE EXISTING STATE HIGHWAY 52 ACCESS ENTRANCE :
THAT PART OF THE SOUTHWEST QUARTER OF SECTION 2 , TOWNSHIP 1
NORTH, RANGE 66 WEST OF THE SIXTH PRINCIPAL MERIDIAN, COUNTY
OF WELD, STATE OF COLORADO, BEING MORE PARTICULARLY DESCRIBED
AS FOLLOWS :
BEGINNING AT THE WEST QUARTER CORNER OF SAID SECTION
2 ; THENCE SOUTH 00 DEGREES 00 MINUTES 00 SECONDS EAST ON AN
ASSUMED BEARING ALONG THE WEST LINE OF SAID SOUTHWEST QUARTER
A DISTANCE OF 50 . 00 FEET; THENCE NORTH 89 DEGREES 36 MINUTES
45 SECONDS EAST PARALLEL WITH THE NORTH LINE OF SAID
SOUTHWEST QUARTER A DISTANCE OF 1431 . 79 FEET TO A POINT
1192 . 00 FEET WEST OF THE EAST LINE OF THE SOUTHWEST QUARTER
OF SECTION 2 AND THE TRUE POINT OF BEGINNING; THENCE SOUTH 00
DEGREES 20 MINUTES 10 SECONDS EAST ,PARALLEL WITH THE EAST •
LINE OF SAID SOUTHWEST QUARTER A DISTANCE OF 75 . 00
FEET; THENCE SOUTH 89 DEGREES 00 MINUTES 00 SECONDS WEST A
DISTANCE OF 230 . 00 FEET; -THENCE NORTH DEGREES 20 MINUTES 10
SECONDS WEST PARALLEL WITH THE EAST LINE OF SAID SOUTHWEST
QUARTER A DISTANCE OF 75 . 00 FEET; THENCE NORTH 89 DEGREES 36
MINUTES 45 SECONDS EAST PARALLEL WITH SAID NORTH LINE OF THE
SOUTHWEST QUARTER A DISTANCE OF 230 . 00 FEET TO THE TRUE POINT
OF BEGINNING . ` ===
,.; ,•
mr-r 201958 5ie5
Recordd_.__--b..e.�. f ) u a«k t'C M. alt;kA ae 5h
Receodon No. . 1'S•''�_)�ti%---._Aff1 f ,tt_, Recorder.
•
fQ„1J15 .'.petit made taboo That day of October ,t,the
= a ear , a e
:our Lord one thoand nine hundred and PSit7-401.111:t between
, MIDI EIIJIAIRi
TI v
'_d� Li:',e, County of Weld and State of Colorado,of the
. ,
. s• and
wl
s - CRA L. VAYrER and ALTA I, MUTER
2
a,.�_3` _ County of Weldid and State of Colorado, of the
t .e.,-nd pan:
WITNESSETH. That the said party of the first part for and in consideration of the sum of
' Ten Dollars and other good and valuable considerations-- - MAW*
a . : 7 ,1 rte tint part in hand paid by the said parties of the actor! ;art, tire receipt whereof is
t , a:kr._.. e!gcd. ha a rand, bargained,sold and conveyed. ac! a presents does
. - e . ,t, ., . sill c--.rya confirm unto the ofd parties of the second part, to pass not in tenancy i ,mw on
. .. _ of arr. rh•ir ,.signs and the heirs and assigns of such survivor turner.all the fol-
_ , - . ,.,ed lot a or rarer:s of land.situate,lying and being in the
ff
County of Weld and State of Colorado. to-wwit.
The Southwest Quarter (SW+), of Section Two (2),
in Township One (1), brth of Range 66, West
°^ of the 6th P. M., Weld County, Colorado.
YeCRi "' .. DTs iC Ks vi ' e;.
fig--Ms IIt � t
TOGETHER noli all ....,. -ingular the hereditamuit„ and appurtedances trcr runt he. ;:.. .. : , e
.. .- -tons ten:antlers,anti teatntlerr rents. is.ucs I I
:m
erest. claim anti demand whateneser of the said part 7 •f the .r t part, either t
!An E . ., in :Old to the shave bargained premises, tthehreditarnenb and appurtenances.
TO HAVE AND TO HOLD the said premises above bar coined and described, with alputtenararen, urn thy
, -.. , ,. e.lord part, tilt curvIvor of them, their assigns, and the heirs and assigns ai such stovtvor for-
, Ann :,,, a:.t art y of the lint part. for his reify his heirs. executors, and administre•ors. do es
,,..,a.,, toot l'area,, and agree to and with the said parties of the second part, the ,,Irvt.,, ,: then,. Ii,dr
a--•••••• at,d ,n s and a,.lcn.,.f scab survivor. that at the tinge of the enscaling and drhocri-g . :hest present..
,l •,.i.e `v
he is tort l rf :hr p Lobo, above conveyed. as of good. sure reelect, ahorlihr an: ip,!eftasible taut
• -^-roar.,,, in law, In tic simple. and ha a good right. full power and lawinl authority to grant, bargain.
,,..to:-, tl.e tam, in manner and form aioresaid, and that the same are free and clear front all former and
C... r wen:, bargasus. sales, liens, taxes, assessments and incumbranres of whatever kind or nature :
Htoept taxes for 1958, due and payable in 1959, which the Grantees herein assume
and a t^tree ploy.
soil i' al- a bnrgainrd premises in tltr •Ipi,a aid peaceable poeae,•!on of the gaud par::-. of o e ow rl part. The
• floorthem. trip ogna and the limes and assigns at such sun-war, against ail a.., ..- y per•: .'n •f pi` ose.rs
-ot ,I;a i , ing r Blain, the whale or any part thereof, the said part 7 of tl:r :c,l part shall and rs to
N'ai,k N`ti. AND I'OGCVER DEFEND.
c: v.I!NE'S \\'HER e.OE, the :aid port 7 of the first part ha ■ herrmto set hill hand and
sci thv day and year first above written.
t .., .f
n-.1. p,vtr-0 Jilt: Delivered in the Presence of� ' v` y__~ sue- ISEALI
Zahn-telleini6
-... .. -. (SEA1,1
_... .. ____ _ ___.. t SEAL)
STAf OF,COLORADO.} T The foregoing tar
..
.a instrument as ail r,..l•da ! i cr, t lot i
County'oi Waist Cctoher
T q H ._.. .. __ . 19_58, by John Lallerass
Y
_ ____ ._.
r a y Witness My Hestd and Of(Idal SW _. .__ _. _
iti S 959
3 l r my Cnamirm Ripka _ _._.. .___ ..
/ `�
Ha1r7
WARRANTYDZLD—Te Julie Tenors—Tribune, Grtxler. Comrade.
AFFIDAVIT OF INTERESTED LAND OWNERS http://maps.merrick.com/website/welccll'set...0027,147102000032,147102300067,&Par2=500
•r r
1
AFFIDAVIT OF INTERESTED LAND OWNERS
SURFACE ESTATE
Subject Parcel: 147102000041
THE UNDERSIGNED, states that to the best of his or her knowledge the attached list is a true and accurate
list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld
County Assessor of the owners of the property(the surface estate) within 500 feet of the property being
considered. This list was compiled utilizing the records of the Weld County Assessor available on the
Weld County Internet Mapping site, http://www.co.weld.co.us, and has not been modified from the
original. The list compiled from the records of the Weld County Assessor was assembled within thirty
days of the application's submission date.
Signature
Date
Property Owners Within 500 ft. 9f Parcel# 147102000041
NAME I MAILING ADDRESS I PARCEL IDENTIFICATION #
AUSTIN RONALD D & 16651 WCR 12
SHARON A 147102000027
FORT LUPTON,CO 80621
16267 WELD CORD 12
FLORES-BOWEN MELISSA C & 147102300067
FT LUPTON,CO 80621
16586 HWY 52
HELVIG STEVEN J 147102000059
FORT LUPTON,CO 80621
8791 CIRCLE DR
HIGHWAY-160 PARTNERSHIP 147102000064
WESTMINSTER,CO 80030
16307 HWY 52 -PO BOX 311
JESSER GLENN F &MARY JO
& 147102000063
ANN-1/2 INT
FT LUPTON,CO 80621
RICE DALE E & THEORA M RICE FAMILY TRUST
TRUSTEES 1666 POWELL CREEK ROAD 147102000032
WILLIAMS,OR 97544
460 PRAIRIE RIDGE RD
VAWTER JAMES R 147102000039
HIGHLAND RANCH,CO 80126
1 of 1 03/22/2001 9:52 AM
MOBILE HOME PETITION
Do not sign this petition unless you are an "owner" of real property within 500 feet of the property which the mobile
home is proposed to be located on. An owner is a person holding fee title to real property. You are an "owner" if
you hold a contract to purchase real property which obligates you to pay general taxes on that property. In this
instance, the seller may not sign this petition.
We, the undersigned owners of property within 500 feet of the property which the mobile home is proposed to be
located on, do not object to the issuance of a zoning permit for a mobile home to be used as a
gpoessc>ry re rAe Far 111 •
Please do not sign Mr. and Mrs. - sign individually. Please do not sign this unless you have read all of the text.
Signature Mailing Address Telephone Number Date of Signing
i' Alai Ste► -303 S57 "pi 6 jc- /o-0/
7 <' c, S z 303_ ,x-5`7 -15`6><L" / ' -42,i
1
"4 -Lf-6 on I` l(n271 �l-L L7 3b3837 2SZ 'Z �D O)
yQOLVPi��7 ' 24 ') WO' /23U3
Q � 1-491,e---r.- /6.?6, cock', / a ,e3 - - 9/o 3
t-cpti zs O5-7 it k/ A Son -859- `/4C
� ,p
-c>c fav-z✓ �u•1-0r,-J O,6o� 3// 9-rc y _<',r-ea 3� :578-s--7;,794% / 4
�</t flu 44-4' par-1 /96)174/ -� ( ) 31),38-C 7-2 •#$-/
- 303 f,:`.> 76 ,/s.le.)
Circulator,' Signature
7
COLORADO DWR - WELL DATA
Applicant: MOUNT WILLIAM L & MARY ANN Receipt No 0339880 Permit 165214
Address: 1062 NO PARK AVE FT LUPTON CO 80621 Phone: 3038571911
Well Location: T1N,R66W Sec 02 NESW PM=S COORDINATES: 23585, 1532W
Division 1 WD 02 County: WELD
Yield(GPM) : 13 .00 DEPTH(FT) : 1040 WATER LEVEL(FT) : 467
Uses: DOMESTIC Aquifer: LARAMIE FOX HILLS
Driller: 827 Pump Installer: 715 Pump Installed: 10/11/94
Activation: PERMIT ISSUED 06/09/92
Status: RECORD CHANGE 09/13/93 New Permit: 07/17/92
Proposed Yield(GPM) =15.00 Proposed Depth(FT) =800 Proposed AF=1.00
COLORADO DIVISION OF WATER RESOURCES - 11/23/98
•
•
• I ND I , i DUAL SEWAGE DI SP' 'AL SYSTr A PsL.s_;; .I T NO . G-5302
WE—. `:COUNTY HEAL' H '—iEPARTMENT NEW PERMIT
ENVIRONMENTAL. HEAL I H SERV I OES
117 1L N AVENUE ._UUR- . GREELE.Y CO 90631
5 EXT . 2225
OWNER MOUNT , WILLIAM/MARY ANN ADDRESS 1062 N PARK AVE PH ( -03) 857-
/6a34:› gb{!sasT LUPTON CO 80621
ADDRESS OF PROPOSED SYSTEM J-':W . .
-52 & R--}- 1
FT LUPTON CO 00621
LEGAL DESCRIPTION OF SITE: SWI SEC 2 -1-6.l? 1 RNG 66
SUBDIVISION : N/A LOT 0 BLOCK 0 FILING 0
USE TYPE : RESIDENTIAL HOUSE
'SERVICES: PERSONS 4 BATHROOMS 2.00 LOT SIZE 35 .00 ACRES
BEDROOMS 3 BASEMENT PLUMBING YES WATER SUPPLY PWELL
APPLICATION FEE $150.00
RECD BY JOANNA GALLEGOS, X-STAFF SIGNED BY MARY ANN MOUNT
DATE 07/16/93 DATE 07/16/93
PERCOLATION RATE 5.0 MIN PER INCH LIMITING ZONE 0 FEET
SOIL TYPE UNSUITABLE PERCENT GROUND SLOPE 0% DIRECTION
REQUIRES ENGINEER DESIGN YES IN 100 YEAR FLOOD PLAIN ZONE NO
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON-SITE SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK -1.000 GALLONS. ABSORPTION TRENCH SO . FT .
OR
ABSORPTION BED 846 SO. F T .
IN ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
CONDITIONS: ------
THIS PERMIT S GRANTED TEMPORARILY TD ALLOW CONSTRUCTION TO` COMMEN . THIS PERM
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SE
FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDIN
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OH FINAL
APPROVAL . THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR' INADEQUACY OF THE
SEWAGE DISPOSAL SYSTEM.
---9� PAN SMITH 02/24/93
��� 0G _ ENVIRONMENTAL SPECIALIST DATE
T PERMIT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HA
THIS I � NOT TRAI 1SF-_RABLC
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE . BEFORE ISSUING FINAL APPROVAL 0
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO‘IMPOSE ADD I
TIONAL TERMS AND CONDITIONS REQUIRED TO MEEr OUR REGULATIONS ON A CONTINUING BA
SIS . FINAL PERMIT APPROVAL IS CONTINGENT UPON Tf-rE FINAL INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY� HEALTH DEPARTMENT.
SYSTEM INSTALLER _ T �6 . _ FINAL INSPECT 0 ATE �a6' 5
SYSTEM ENGINEER _ APPROVAL ----
TYPE OF SYSTEM IN TALED - �' � ! ENVIRONMENTAL SPECIALIST
THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE. COUNTY
OR LOCAL ' REGULATORY OR BUILDING REQUIREMENTS . NOR SHALL IT ACT TO CERTIFY THAT
THE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY ANC
LOCAL REGULATIONS ADOPTED PERSUANT TO ARTICLE 10. TITLE 25. CRS 1.973 . AS AMENDE
EXCEPT E"OR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FC
ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2) .
ORIGINAL-APPLICANT COPY-WCHD WCHD-EHS t-1A'-' . _704
i*VELD
( n R 16230 Highway 52
Fort Lupton, CO 80621
20at "N -7 Al9: 15 (303) 857-1911
May 2n°,2001
RECE1
Weld County Commissioner -; '' LD
District 3
Robert Masden
Centennial Center
915 10th Street
PO Box 758
Greeley, CO 80632
Dear Commissioner Masden;
I am writing in regard to a re-application I made this year to the Weld County Planning
Department to place a mobile home on my property for someone to live in and assist me with the
care of my animals: 9 sheep at present,4 horses,chickens and dogs, and to be there when I am
gone.
I applied for this permit two years ago and received a letter from the Planning Department
denying the permit. I had already purchased a mobile home, so I sold it after I received the denial
letter. Later,a man delivered a permit to my home. Since I had already sold the mobile home
and did not find another inexpensive one, I cancelled the permit.
At this writing, I have received two letters(of which I am enclosing a copy of each)one
denying my request and one referring it to the Fort Lupton Planning Commission. I attended
their meeting on April 10th, 2001 and they were in approval. I called Wendi Inloes on April 20th
and was told it would next go before the Board of County Commissioners,but as yet have not
had any further information from anyone.
I realize with all the growth that is going on in this county that you are very busy,but I
hpe that you will give consideration to my request for a temporary zoning permit for a mobile
home to have someone assist with the care of my animals,be here when I am gone and work on
the fencing, corrals,arena,round pen, cleaning out the horse stalls, and repair them,reseeding,
cutting and discing the rye.
I am also enclosing a copy of the required signatures of my neighbors that they are
agreeable to my having a temporary mobile home here and a copy of the previous permit that was
issued to me.
Thank you for your time and I look forward to hearing from you soon.
Sincerely,
7
Mary Ann Plonka
irT
ZarN #azt5Q,
16230 Highway 52
Fort Lupton, CO 80621
(303) 857-1911
May 7th, 2001
Weld County Commissioner
District 3
Robert Masden
Centennial Center
915 10th Street
PO Box 758
Greeley,CO 80632
Dear Commissioner Masden;
I am writing in regard to the hearing which will be held on May 14th, 2001 at 9:00a.m. for
a zoning permit for a mobile home#2256. The notice was posted Friday,May 4th, 2001, on my
property. I regret that I will not be able to attend the hearing because I have made arrangements,
several months ago,to visit a friend in Japan. I was hoping to have this resolved before my trip,
but I hope it can be handled with a positive solution without my presence.
Thank you for your time and I look forward to hearing from you soon.
Sincerely, 27,7 9
i //a/U./ a ; 2 .-72- %
Mary Ari Plonka
(4. EXHIBIT
ZPm H %
U.S. Postal Service
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
C
u'1
Ill
CI
FL) Postage $
I-9
m Certified Fee
O
Postmark
Return Receipt Fee Here
a (Endorsement Required)
o Restricted Delivery Fee 5— 2J- 116/
o (Endorsement Required)
o Total Postage&Fees
fLa ll Reci ient's Name PleasePrint Clean n p ( y)(To be completed by mailer)
o /ilia A�1t1__PL a:≤a
Street, No.;or PO Box No.
o /b 010 1 .4tI11sg .-5:&______—___—___._.
o City,,,State, e+4i � •
N City,
2L10/0/1 L'D d'D . /
SEN 0E': Ce M•LETE THIS SECTleN CUh]PLE rc THIS StCOOuoff DELNERY
• Complete items 1,2,and 3.Also complete A. Received by(Please Print Clean) R-D e of Delivery
item 4 if Restricted Delivery is desired. Line St MD AI( 2-2-
• Print your name and address on the reverse
so that we can return the card to you. C. Signature
• Attach this card to the back of the mailpiece, 41 �a v1e 0 Agent
or on the front if space permits. X( Un.(,IiX. N- Ivt87 ❑Addressee
D. Is delivery address different from item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No
Mary tine P/0'41/4t
/ ype
rI6 9130 i/, Aivi.t 5p
red /� /(fir// OQb42/ 3.,,S[e Cartrvice ed
/� 74.Certified Mall ❑ Express Mail
/❑ Registered Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 yes
2
102595-00-M-0952
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