HomeMy WebLinkAbout20183506.tiffUSE BY SPECIAL REVIEW (USR) APPLICATION
DEPARTMENT OF PLANNING SERVICES * 1555 N. 17T" AVENUE * GREELEY, CO 80631
'w . weldgc vr. qpm * 970-353-6100 EXT 3540 * FAX 970-304-6498
FOR PL.,NNIN - DEPARTMENT U. E:
AMOUNT $ I Fy
I APPLICATION R
y9 U
if Di
CEIVED BY .
DATE RECEIVED: Jr I 3,41 I'�
CASE # ASSIGNED; jfl\S4-OOEfi
PLANNER ASSIGNED: —Pp.
Parcel Number*: 1 ma eta C B-3- 03..- _
Address of site: � 715(0 Mm/c 54- Lonron,L CS)
Legal Description:
Zone District: tic, Acreage: q 6 Floodplain:StiN Geological Hazard:OYIN Airport O erlay:OY
FEE OWNER(S) OF THE PROPERTY:
Name: Albino
Lot fl Encitsdergigits
(*A 12 digit number on Tax I.D.
information, obtainable at
�W W rvig ekduov corn).
Company:
Phone #: �p3.'�76r r 3G2 Email: Iei tS
Street Address: 7!5C,' 141ne
City/State/Zp Code: Lbo r1 ir CC -7 —
Wes
Section:
Township: , N Range:eta-W
Name:
Company:
Phone #:
1 tote- Ciatissfeilos
5
nc ,1ir
3493 Ceorcstlhe_
Street Address: ?!S(aa die ,S{.
CityiState/Zp Code: toa:nc. att
Name:
Company:
Phone #: 7- co ?Da
Email:
Street Address: fittitt!•
SSaksr d A . 7jr/-711os
City/State/Zip Code: Body
APPLICANT OR AUTHORIZED AGENT: (See below Authorization must accompany all applications signed by Authorized Agents)
Name:
Company:
Phone #:
p\-iNcrin \\te.
V91 'c ri C t C CC C
Ts - f'2 sjk1≥ Email: .'rn1/4,_Ist
°
Street Address:
City/State/Zip Code:
PROPOSED USE:
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 all fee owners 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 e'iden - ust be included indicating that the signatory has to legal
authorityto ; ign for the corporation.
AI&nv &541/05
Srgn tire: Owner or Authorized Agent
Print Name
Date Sig nature: Owner or Authorized Agent
ewl iNd C . 3tafllc6
Print
Cassandra
7 -1225 -67 -
Date
Rev 4/2016
DEPARTMENT OF PLANNING ER I E
1555 N 17th AVE
GREELEY, CO 80631
PHONE: (970) 353-6100, Ext. 3540
FAX: (970) 304-6498
AUTHORIZATION FORM
I �A�a4\ \Ae DWlc:cri CO\ LC LtC repres�nt�`�l�� Ovixs\jii�vS, for the property
(Ager�UA r licant) � �1 (Owner)
located at '�,�� h)ar31\Lf
LEGAL DESCRIPTION: SEC TWN -2-1° RNG _ 64-7 west-
UBDIVI ION NAME:
LOT Zgr BLIP.
I can be contacted at the following
Home
Work .303-902`s30Z
Email: ..rws1/4,njaaa\iott \cr, O A^.
The property owner can be contacted at the following
Email:
Correspondence emailed to:
(Check one)
DATE 7- 3l - /
OWNER'S INATURE
Home
Work la3"S-?I'?-G-D
cAn \o. 1/4 C. 00411%
IX Agent/Applicant
Property Owner
" INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ;' ;'
TIME RECEIVED
November 3i 2017 at 9;30;50 AM MCAT
REMOTE CSID
DURATION PAGES STATUS
26 1 Received
2017 .11.03 09:30 AM
ijitScri
N90
DEPARTMENT OF PLANNING SERVICES
BUILDING INSPECTION DIVISION
1555 N 17TH AVENUE, GREELEY, CO 80631
(970) 353-6100 X354C?
AUTHORIZATION FORM
P 1/ 1
represent fth6uuio r0th'/mt'for the
(Applicaryi) (Owner)
property located at '��'5(a 1golAn+4 Sir It) itt 11b Co 0 gintiodi
Legal Description: Qtr/Qtr Becton
Subdivisiond hilas
I oar) be contacted at the following phone #'s:
township NI Range
Lot Block .. ..
Horne 0_ 2,33 "�3/ _...�. ,
Work
MMIPITE
Cell 30 3 2.•
..
Cor responderics mailed to (only one): reApplicant O Property Owner
pers Signatur
1 It
Date
Il!M!MEINEW.wer re—
w
R der Reddick
From:
Sent:
To:
Cc:
Subject:
Attachments:
Tracy Case <TCase@Firestoneco.gov>
Thursday, September 14, 2017 5:19 PM
Ryder Reddick
j h epp@me.com; caroline@carolinesct.com
7156 Maple St - PRF17-0160
PRE17-0160.pdf
Thank you for the opportunity to comment on this application.
The Town of Firestone would be interested in potentially annexing the entire subdivision, but not on a lot by lot basis.
Sable Avenue/WCR 22 is a planned arterial in the Firestone Master Comprehensive Plan, therefore, we would discourage
the County approving any secondary access for any individual lot to the planned arterial roadway.
Sincerely,
TRACY CASEI Senior Planner
Town of Firestone I Planning & Economic Development
8308 Colorado Blvd. Ste. 200, Firestone, CO 80504
Direct 303.531.6260 'Fax 720A76.4232
tcasewi Fir'estcne O,, =Firestone ,go r
From: Ryder Reddick rreddick a t etdg v.com>
Date: August 15, 2017 at 2:56:23 PM MDT
To: Jason blepp <1hu ( !nic.conn , Caroline Bustiiios <caroline rcaroliinesctff.
Subject: USR 7 Day info update thanks for sending the COC's
Thanks Jason,
We still need for you to get in touch with the town of firestone and discuss if there is any opportunity or
possibility for annexation into the town as the property is within the Intergovernmental Agreement area
between the town and the County. Send me a a letter from the town of firestone explaining you talked
with them about the use being proposed on this site for our current Use by special Review permit
application and have them provide any feedback they have regarding the proposed use, If they don't
want to annex or the Bustillos don't want to annex after chatting please see if the town can say they
have no issues with us moving forward with the case at this time so we can expedite the application we
have through the completed process.
I did review what you had so far and I still need the affidavit of interested owners document signed by
all property owners, I need the Authorization form signed by both Caroline and Cassandra as well for
Jason to be the authorized agent on this case I will need more elaboration of questions 5,6,7,8,11 and 14
as we just need more specific info for these questions, if you have questions about the info we are
looking for please let me know and I can elaborate. Also we need access photos for all access points
existing and proposed and we need pictures going all for main directions of the road into out of and to
both side of the access point on the public maintained County Roadway.
Again let me know if you have questions and thanks for getting me this COC
1
Best Regards,
Ryder Reddlck
Planner I
Department of Planning Services
1555 N 17th Avenue Greeley, CO 80631
tel: (970) 353-6100 ext. 3527
Confidentiality Notice: This electronic transmission and any attached documents or other writings are
intended only for the person or entity to which it is addressed and may contain information that is
privileged, confidential or otherwise protected from disclosure. If you have received this communication
in error, please immediately notify sender by return e-mail and destroy the communication. Any
disclosure, copying, distribution or the taking of any action concerning the contents of this
communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Jason Hepp [niai'ftoriiie pc e,com]
Sent: Thursday, August 10, 2017 8:13 AM
To: Caroline Bustillos era roline caroiinesct_ com ; Ryder Reddirk crreddick@wgitov.com>
Subject: Certificate of Conveyances
Please see the attached Certificate of Conveyances.
Cheers,
Jason Hepp
303 902 5302
2
Use by Special Review (USR) Questionnaire Answers
Planning Questions:
1.) The primary use of the property will remain residential. In addition, we have a Concrete Construction
Services Company and will store vehicles, material and equipment owed and used by our home
business. No customers will enter the property and there is no retail operations conducted at the
property. There is a second home on the Property that was previously approved prior to and as a
condition of our acquisition of the property and it will be utilized as a multi -generational, caretaker, and
or guest dwelling.
2.) This proposal is consistent with the Weld County Code, Chapter 22 or the Comprehensive Plan, as
this chapter supports opportunities for home businesses (Section F. A. Goal 6. Item 2) and encourages
multi -generational, caretaker, guest and accessory quarters (Section F. A. Goal 6 Item 3).
3.) This proposal is consistent with the Weld County Code, Chapter 23, and the zone district in which it is
located in that (M) one single family dwelling unit other than those permitted under section 23-3-20 A
and (P) Home Business are permitted uses.
4.) Surrounding properties are rural with similar uses. The surrounding properties have riding arenas,
tractor -trailer storage and chicken farm operations.
5.) There are no set hours of operations as we do not conduct retail operations at the property and our
work (other than office and storage) is conducted off site. Our typical day begins a 8:00 am and we
return at 5:00 a m .
6.) Our employees do not work on site. Our employees meet us at our job sites, however it is customary
for myself and one other Employee to meet at the property in the morning and return in the evening.
The maximum number of employees that could go to the property in any given day is my three sons, 2
unrelated employees and myself. This would only happen in a rare occasion. Even though my sons and I
work together for our company we could go to the property to visit my daughter who lives there. 7.)
N/A, Our employees do not work on site. There is no shift work.
8 ) The maximum number of employees that could go to the property in any given day is my three sons,
2 unrelated employees and myself. We do not receive any deliveries at the site.
9.) Not a Dairy
10.) Approximately 2000 sqft of gravel. When we acquired the house there was no gravel in the
driveway and we added gravel to control mud and dust etc. The surface of the rest of the site is a
mixture of native grasses and yard landscaping.
11,) N/A . A typical day includes one employee and myself parking our personal vehicles in the driveway
and leaving in a work vehicle.
12.) Existing landscaping includes typical grass, trees, planting beds and native areas. We would like to
plant additional trees on the east and west sides of the property.
13.) Existing fence. No additional fence planned at this time.
14.) No additional screening is proposed. Utilizing existing fence, landscaping and structures as
screening.
15.) N/A
16.) Frederick Firestone Fire Department
17.) We would like to add a secondary access to the property off of CR22 and to build a garage/barn to
the property, Plans and permits to follow prior to building these improvements.
Engineering Questions:
1.) Passenger Cars 6, Commercial Vehicles 3
2.) The proposed primary entrance for the business is south of the property off CR 22 the current
approved access being utilized however is off Maple Street to the north of the property through the
current driveway.
3.) N/A My one employee and myself come from the West in the morning and in the evening.
4.) Morning and Early Evening
5.) We would like to add a secondary access to the property off of CR22. Plans and permits to follow
prior to building these improvements,
6.) 1A84 At this time we are not planning on any building improvements such as grading, building
additional
1 _ L _ _ 1_1' _ f it 1 1 ■ ■ I • M 1 II
u���uri r �� rr�r" or- dUUIrlg rrriperviuus Sur i dLtS trrd L would impact rIIsior Icd; dr dlrldge. Il at soriie
point in the future we decide to pursue any such improvements we understand that this requirement
will be necessary as a part of the permit process.
Environmental Questions:
1.) Property is served by Weld County Water District. See attached Letter.
2.) Septic System. G700So1.
3.) Concrete Forms, Equipment (Bobcat, trailers), Construction materials
4.) N/A
5.) N/A
N/.A.
7.) N/A
8.) N/A
9.) N/A
10.) N/A
11.) N/A
Building Questions:
1.) See Drawing
2.) My daughter lives in one of the houses, the other house is vacant. We are planning on moving into
the vacant house. There is a storage shed, a hay storage building and well water shed.
3.) 4 existing Structures. They serve as storage for hay, water pump, lawn mower and yard equipment
Weld County Public Works Dept.
1111 H Street
Pao. Box 758
Greeley, Co 80632
Phone: (970)304-6496
Fax: (970)304-6497
Applicant
game f� b testy ear. _ Ind � �i�1.5�4.iat��+-
544 ICS
Company
Address 115(0 totcy 1�
City L." rtc fvth State Zip
Business Phone
Fax
)3)11-
3n3 9 ���&-f
E-mail
Parcel Location & Sketch
The access is on WCR 234
ACCESS PERMIT
APPLICATION FORM
Property Owner (If different than Applicant}
Name Albino &rolnic. �' (ks cEror &u54:�os
Address , _..,,. 11562
1562 %� AMC'ISIS
City to hY16)1fr Statetb Zip _ '��`i'
h
Phone �c7S `r�Co
Fax Zo3 &SL C250Cp
E-mail CtVSat L)►'lCirmeAe.. (Li IL,^fwair
A = Existing Access A= Proposed Access
Nearest Intersection: WCR 224.& WCR rarbeititi Cat -
Distance from Intersection
Parcel Number
Coto C+
13tIO3O3ct4
Sect i o n/Township/Range
T2, N R (elf
Is there an existing access to the property?( YE5 NO0
Number of Existing Accesses
Road Surface Type & Construction Information
Asphalt rl Gravel Treated a Other
Culvert Size & Type
Materials used to construct Access_
Construction Start Date
Proposed Use
D
•
Temporary (Tracking Pad Required)/ $75
Small Commercial or Oil & Gas/$75
Field (Agriculture Only)/Exempt
Finish Date
uain
Wait, Ffrberto E -AD%
gy-ofru eel
WCR
A iro
ke?
Nes'
1),
WCR 22.
air ----�iio14k bJ C�4-,p
C. 0 levy 'Le ligLi
['tingle Residential/$75
Large Commercial/$150
Is this access associated with a Planning Process? N
Required Attached Documents
- Traffic Control Plan -Certificate of Insurance
0
RE
Industrial/$150
(Subdivision/$150
PUD
Other
a
- Access Pictures (From the Left, Right, & into the access)
By accepting this permit, the undersigned Applicant, under penalty of perjury, verifies that they have received all pages of the permit
application; they have read and understand all of the permit requirements and provisions set forth on all pages; that they have the
authority to sign for and bind the Applicant, if the Applicant is a corporation or other entity; and that by virtue of their signature the
Applicant is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws
regarding facilities construction.
Signature , r `t rr .11:fetsitcr
Approval or Denial will be issued in minimum of 5 days.
Revised Date 6/29/10
inted Name it I b 15a-Sii `1OS Date 1 1251
Approved by
Ryder and Mike,
Please see the attached revisions to our application based upon our last meeting and thank you
for reaching out to us. We hope that this finally includes everything you need to move forward
with the approval process. We are sorry that this has taken so long. We want to assure you
that we want to do the right thing and that you know we appreciate your assistance as this
process has been extremely difficult for us to understand as this is all new to us. We are
grateful for your thoughtful consideration and want to apologize for any additional work of
stress our misunderstanding has caused.
Albino and Caroline Bustillos
Use by Special Review (USR) Questionnaire Answers
Planning Questions:
Our Company is: ABS Concrete Inc
t
1.) The primary use of the property will remain residential. In addition, we have a Concrete Construction
Services Company and will store vehicles, material and equipment owed and used by our home
business. We have built a fenced area to keep these materials out of the view of the neighbors and
would like to keep 3 containers on the property (See attached Map) to keep a vast majority of the tools
and materials inside and out of view. No customers will enter the property and there is no retail
operations conducted at the property. There is a second home on the property that was previously
approved prior to and as a condition of our acquisition of the property and it will be utilized as a multi -
generational, caretaker, and or guest dwelling.
2.) This proposal is consistent with the Weld County Code, Chapter 22 or the Comprehensive Plan, as
this chapter supports opportunities for home businesses (Section F. A. Goal 6. Item 2) and encourages
multi -generational, caretaker, guest and accessory quarters (Section F. A. Goal 6. Item 3).
.) This proposal is consistent with the Weld County Code, Chapter 23, and the zone district in which it is
located in that (M) one single family dwelling unit other than those permitted under section 23-3-20 A
and (P) Home Business are permitted uses.
4.) Surrounding properties are rural with similar uses. The surrounding properties have riding arenas,
tractor -trailer storage and chicken farm operations.
5.) There are no set hours of operations as we do not conduct retail operations at the property and our
work (other than office and storage) is conducted off site. Our typical day begins a 8:00 am and we
return at 5:00 a m .
6.) Our employees do not work on site. Our employees meet us at our job sites, however it is customary
for myself and one other Employee to meet at the property in the morning and return in the evening.
The maximum number of employees that could go to the property in any given day is 6 people. My
three sons, 2 unrelated employees and myself. This would only happen in a rare occasion. Even though
my sons and I work together for our company we could go to the property to visit my daughter who lives
there. My Daughter is an owner of the company and is our site manager.
7.) N/A. Our employees do not work on site. There is no shift work.
8.) 6 People. The maximum number of employees that could go to the property in any given day is my
three sons, 2 unrelated employees and myself. We do not receive any deliveries at the site.
9.) Nota Dairy
10.) Approximately 2000 sqft of gravel. When we acquired the house there was no gravel in the
driveway and we added gravel to control mud and dust etc. The surface of the rest of the site is a
mixture of native grasses and yard landscaping.
11.) N/A . A typical day includes one employee and myself parking our personal vehicles in the driveway
and leaving in a work vehicle.
12.) Existing landscaping includes typical grass, trees, planting beds and native areas. We would like to
plant additional trees on the east and west sides of the property.
13.) Existing fence. We have built a fence to contain our business tools and materials to block. the view.
from the neighbors.
14.) No additional screening is proposed. Utilizing existing fence, landscaping and structures as
screening.
15.) N/A
16.) Frederick Firestone Fire Department
17.) We would like to add a secondary access to the property off of CR22 to keep the al
away from the neighbors.
Engineering Questions:
1.) Passenger Cars 6, Commercial Vehicles 3
I of the business
2.) The proposed primary entrance for the business is south of the property off CR 22 the current
approved access being utilized however is off Maple Street to the north of the property through the
current driveway.
3.) N/A My one employee and myself come from the West in the morning and in the evening.
4.) Morning and Early Evening
5.) We would like to add a secondary access to the property off of CR22. Plans and permits to follow
prior to building these improvements.
6.) At this time we are not planning on any building improvements such as grading, building additional
structures or adding impervious surfaces that would impact historical drainage. If at some point in the
future we decide to pursue any such improvements we understand that this requirement will be
necessary as a part of the permit process.
Environmental Questions:
1.) Property is served by Weld County Water District. See attached Letter.
2.) Septic System. G 700S01.
3.) Concrete Forms, Equipment (Bobcat, trailers), Construction materials
4.) N/A
S.) N/A
6.) N/A
7.) N/A
8.) N/A
9.)N/A
10.) N/A
11.) N/A
Building Questions:
1.) See Drawing
2.) My daughter lives in one of the houses and is an owner of the business, the other house is vacant.
We are planning on moving into the vacant house. There is a storage shed, a hay storage building and
well water shed.
3.) 4 existing Structures. They serve as storage for hay, water pump, lawn mower and yard equipment
PURCHASE AGREEMENT
THIS PURCHASE AGREEMENT 0 this "Agreement"), effective as of March 1, 2018
is entered into by and between Cassandra A. Bustillos ("Purchaser") and Albino Bustillos
("Seller''),
WHEREAS, Seller owns one thousand (1,000) shares of common stock issued by ABS
Concrete Inc. (the "Company") and is the sole shareholder of the Company;
WHEREAS, Seller desires to transfer to Purchaser and Purchaser desires to acquire from
Seller fifty (50) shares of Company common stock (the "Purchased Shares"), on the terms and
conditions set forth in this Agreement:
NOW THEREFORE, the parties agree as follows:
1, Purchase, Subject to the provisions of this Agreement., with effect as of the date set
forth above, Purchaser hereby unconditionally and irrevocably purchases the Purchased Shares
from Seller, free and clear of any security interest. liens, restrictions or encumbrances of any kind
(other than as provided by applicable law or in the Company Agreement) (collectively, "Liens").
Seller hereby sells and assigns the Purchased Shares by delivery of an assignment in the form
attached hereto. Seller and Purchaser agree that the value of the Purchased Shares is $10,000.00.
As consideration for the purchase of the Purchased Shares, Purchaser shall pay to Seller, cash in
the amount of $10.00 and the remainder of the value of the Purchased Shares shall be considered
a gift from Seller to Purchaser.
2. Representations, Warranties and Covenants of Seller. S Eller represents and
warrants to Purchaser with respect to such Seller, as follows:
(a) The Purchased Shares are owned beneficially entirely and completely by
Seller, free and clear of any and all Liens. Seller hasnot granted any rights, warrants, options,
subscriptions, agreements or commitments to sell or acquire the Purchased Shares, any part
thereof, OT any right or benefit related thereto to any person other than Purchaser. Seller agrees
that the Purchase Price represents fair and reasonable consideration to Seller and constitutes the
sole amount to be received by Seller in respect of its Purchased Shares in connection with the
transactions contemplated by this Agreement.
(h) No consents, approvals or filings arc required to authorize or consummate
the purchase of the Purchased Shares as set forth in this Agreement.
(c) Seller has the full and complete right, power, authority and legal capacity
to enter into and consummate the transactions contemplated by this Agreement. This Agreement
constitutes the valid and binding agreement of Seller, enforceable in accordance with its terms.
(d) No suit, action, or legal, administrative, arbitration or other proceeding or
governmental investigation is pending or, to Seller's knowledge, threatened against Seller that
would prevent the transactions contemplated by, or the consummation of the transactions provided
for in, this Agreement.
3 Rejrescntations, Warranties and Covenants of Purchaser. Purchaser represents and
warrants to Seller as follows:
(a) Purchaser has the full and complete right, power, authority and legal power
to enter into and consuninaate the transactions contemplated by this Agreement. This Agreement
constitutes the valid and binding agreement of Purchaser, enforceable in accordance with its terns.
(h) No consents, approvals or filings arc required to authorize or consummate
the purchase of the Purchased Shares as set forth in this Agreement.
4. Tax Matters; Transfer Restricted. Purchaser and Seller acknowledge and agree that
the Company is taxed as an "S corporation" and that neither of deem shall take any action that
would cause the Company to be taxed otherwise_ In addition, Purchaser agrees that she shall have
no rights to transfer the Purchased Shares to any person without the express prior written consent
of Seller; and that, upon request of Seller, Purchaser shall be required to sell the Purchased Shares
to Seller on terms similar to the terms of this Agreement.
5. Miscellaneous.
(a) This Agreement constitutes the entire agreement between the Parties with
respect to the subject matter hereof and supersedes all prior agreements and understandings
between the Panics with respect to such subject matter. This Agreement shall be binding upon
and shall inure to the benefit of the. Parties and their respective successors and permitted assigns.
No Party hereto may assign any of its rights or delegate any of its obligations under this Agreement
without the written consent of the other Party, and anv attempted or purported assignment or
delegation in violation of this sentence shall be null and void.
(h) The representations and warranties set forth in Sections 2 and 3, and the
provisions of Section 4 shall survive the closing of the transactions contemplated by this
Agreement.
(c) The terms and conditions of this Agreement and the rights of the Parties
shall be governed by and construed in all respects in accordance with the laws of the State of
Colorado,
lNT WITNESS WHEREOF, the Parties have executed this Agreement to be effective as of
the date fir t set forth above.
PURCHASER:
SELLER:
ad
Cassandra A. Bustillos Albino Bustillos
Attachment:
Assignment separate from certificate
ASSIGNMENT EPA ATE FROM CERTIFICATE
FOR TEN DOLLARS AND OTHER GOOD AND VALUABLE CONSIDERATION,
the receipt and sufficiency Dr which are hereby acknowledged, Albino Bustillos (the
"Assignor"), does hereby assign, transfer and set over unto Cassandra A. Bustillos ("Assignee"),
all of Assignor's right, title and interest in and to fifty (50) shares of common stock issued by
ABS Concrete Inc., a Colorado corporation (the "Company„) owned by Assignor. Any
certificates evidencing the shares assigned hereby are hereby rendered null and void, whether are
not they are surrendered to and/or in the possession of the Company. Assignor acknowledges
and agrees to mark any such certificate "cancelled" and to deliver such certificate to Assignee in
electronic or original form.
Assignor acknowledges that the Company has authorized the shares transferred hereby
are not required to be certificated; and that this assignment and the books and records of the
Company shall be the sole records of the transfer of shares set forth above. Assignor does
hereby irrevocably constitute and appoint the officers of the Company, attorney -in -filet to
transfer such shares on the hooks of the Company with full power of substitution in the premises.
IN WITNESS WHEREOF, this Assignment Separate From Certificate has been executed
and delivered to be effective as of the I' day of March, 2018.
ASSIGNOR:
Cassandra A. Bustillos
Acknowledged by the Company:
ABS Concrc Inc.
By:
Albino Bustillos, president
G, �X 4LP^-1
��'r^As.L.
Weld County Public Works Dept.
1111 H Street
P.O_ Box 758
Greeley, CO 80632
Phone: (970)304-6496
Fax: (970)304-6497
Applicant
Name inbine3
Company
Address ~11 o 15
0 3 -1 --
Eat a ry I 'Ate Cifisc await&
ACCESS PERMIT
APPLICATION FORM
Property Owner (If different than Applicant)
Name Alb;no r1Ypc
, £°1 E c_ c --5
Address NOS 1/51" M/}p/E Si•
City Lc
h r'`Yl. yi fr StateL-' > Zip SeSr'A+
City L etitenC>bit F State IL5, Zip eel:/-3-:11-1:
lr` 1-f" Phone 3osS rfl C a.sc
Business Phone 3t3 . V . 9ciSeckg Fax 3O3 t Occ,
E-mail .h SIC OvC,:(te-4 +wt
A = Existing Access t= Proposed Access
Fax
E-mail
Parcel Location & Sketch
The access is on WCR
L
Nearest Intersection: WCR 2ez, & WCR er t Ct...r .
�L�
Distance from Intersection “-->
Parcel Number
Section/Township/Range Ce 2 rJte►(el
Is there an existing access to the propertyYES NO C
Number of Existing Accesses 1
Road Surface Type & Construction Information
Asphalt a Gravel
Culvert Size & Type
Treated a Other
Materials used to construct Access
Construction Start Date
u.OO'n
Proposed Use
Temporary (Tracking Pad Required)/ $75
QSmall Commercial or Oil & Gas/$75
Field (Agriculture Only)/Exempt
t
N
f
3
3
Cue tFlAgEo EA) OS
Finish Date
Ian o u t. L" ( z
�3cu e4
to now eit t
MI/Single Residential/$75
Marge Commercial/$150
WCR PIA l ST -
s
kti‘
K
%PP
is this access associated with a Planning Process? No
Required Attached Documents
- Traffic Control Plan -Certificate of Insurance
WCR 22.
Industrial/$150
(Subdivision/$150
USR RE ; PUD r :Other
Access Pictures (From the Left, Right, & into the access)
By accepting this permit, the undersigned Applicant, under penalty of perjury, verifies dial they have received all pages of the permit
application; they have read and understand ali of the permit requirements and provisions set forth on all pages; that they have the
authority to sign for and bind the Applicant, if the Applicant is a corporation or other entity; and that by virtue of their signature the
Applicant is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws
egarding facilities construction.
Signature 70,7.t:
anted Name A I._'
Approval or Denial will be issued in minimum of 5 days.
Revised Cate 6/29/10
CS -1111C. Date f- /26 J ll-.
Approved by
Typical Traffic Control Plan Diagram
f ROAD
WORK
AHEAD
500 FT
1
, ;
:. `!c;
a
0
0
O
i
500 FT
Notes.:
1. The above diagram is typical for normal shoulder work applications. Additional signing may be
required.
2. Vehicles or construction equipment shall not be parked in the travel way and should be moved to the
shoulder. If vehicles or construction equipment are not able to be moved out of the way of traffic,
channelizing devices are required for day use only. No night time obstructions are allowed.
t
' + •r I 1k.e
t •I I4J -• n
vet'_ta ... t { LPL
.ii "..'V.q `I 4:SN1 Pn k 4 -6.•X 1�t it In
�7!
���'. r <VP, {. ' -`+Ill
Hello