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Home My WebLink About992545.tiff 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 121i6ttili 10O — Receipt#(S L-Ka3 Date 11,--21,49 9 Recording Fee Paid Receipt# Date Application Reviewed TO BE COMPLETED BY APPLICANT: (Please print or type, except for necessary signature) LEGAL DESCRIPTION OF SPECIAL REVIEW PERMIT AREA: PARCEL NUMBER: 04 S 1 '3 1 ,, O ,, 0 04 (12 digit number-found on Tax I.D. Information or obtained at the Assessor's Office. Section 3\ , T 9 N, R b5 W-Total Acreage 3 N 4, Zone District A Q Overlay Zone Property Address (if available) ('9j'o vJC$ too , Norm, Co- 20(09 J Proposed Use Lh,c ken ?ti,Kt1 ?rocc45;n7 SURFACE FEE (PROPERTY OWNERS) OF AREA PROPOSED FOR THE SPECIAL REVIEW PERMIT Name: 5ictn WQa6it�l Address: ia392C w'i_Z toe, 44. co. oG>�l5? City/State/Zip: ()QAAi CO Home Telephone:470- SW7-zu'BusinessTelephone47o 395'cage Name: Lc ' vJad4 L l l Address: San1,C 4S cbo L' (- City/State/Zip: Home Telephone: Business Telephone APPLICANT OR AUTHORIZED AGENT (if different than above) Name: Address: City/State/Zip: Home Telephone: Business Telephone: DEPARTMENT OF PLANNING SERVICES USE ONLY Case* (AtlL- IeL W Floodplain: ❑ Yes ra/No Geologic Hazard: o Yes rNo 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 Signature: Owner or Authorized Agent 992545 5 ?l-t1#4 9.1) Ig991 I h;s note_ 'is fa 0MMCnc4 Jsk I aya to ncb y the ,..�i,:1 coo." mis; on that r.yZWOJ(o Ike fo i)rac[SS no Marc T'icti-v (J) oOO c;C.k,lnS 446L furktYS {-hroJ3loo✓f the ro.arsc, aF a year• we v40 v °f eycecd O.00 c,}- kinnt- 1,Mx_ U e 2?�c11 I' I he.?Irjoseci 05c 0f oar property ;Sic o?cn a cusfam Process:4) fGUli j co' U,:cLthcanti +0rkt'15 . 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