2022-05-10_GENERAL DOCUMENTS - M1993041

• Permit No: M1993041
• IBM Index Class Name: General Documents
• Doc Date: 5/10/2022
• Doc Name: Special Use Permit
• From: Boulder County
• To: DRMS
• Email Name: JPL
• Email Name: JLE
• Media Type: D
• Archive: No

DocuSign Envelope ID:89589F90-DEEA-4A44-ADE7-DD274053BD00
Boulder County Land Use Department Shaded Areas for Staff Use Only
Courthouse Annex Building Intake stamp
2045 13th Street•PO Box 471•Boulder,Colorado 80302
Boulder Phone:[phone]
Email:[e-mail]
CountyWeb:www.bouldercounty.org/lu
Office Hours:Mon.,Wed.,Thurs.,Fri.8 a.m.to 4:30 p.m.
Tuesday 10 a.m.to 4:30 p.m.
Planning Application form
The land Use Department maintains a submittaischedule foraccepting applications.Planning applications are accepted on Mondays,by
appointment only.Please cal!303-447-3930 to schedule a submittal appointment.
Project Number Project Name
J Appeal ❑ Modification of Site Plan 'i Road Name Change Special Use(Oil&Gas
Correction Plat Review .1 Road/Easement Vacation development)
Exemption Plat ❑ Modification of Special Site Plan Review State Interest Review(1041)
J Final Plat Use Preliminary Plan
Site Plan Review Waiver Subdivision Exemption
]❑ Limited Impact Special Use � Sketch Plan Variance
.11 Limited Impact Special Use Waiver Resubdivision(Replat) Special Use/SSDP Other:
• Location and Extent ❑ Rezoning
Location(s)/Street Addresses)
55th Street, Longmont, CO
Subdivision Name
Lots) Block(s) S9ctITQ(s)15, 16,21 and 2 Townshlp(s)T3N Range(s) R70W
Area in Acres 709 Existing Zoning Existiinq Use of Property Number of Proposed Lots
Agricultural limestone/shale mining, processing &transport 0
Proposed Water Supply well Proposed Sewage Disposal Method septic
Applicants:
Applicant/Property Owner Email [e-mail]
CEMEX. Inc
Mailing Address
c'tyLongmont state CD Zip[ode 80503 Phone [phone]
A pikant/PropertyOwneriAgent/Consultant Email
County Parks and Open Space Therese Glowacki t lowacki twuldercount Or
g
Mailing Address
5201 St. Wain Road
City State Zip Cod
Longmont CO80503* Phone
303-678-G206
Agent/Consultant Email
Tetra Tech Pam Hora [e-mail]
Mailing Address
351 Coffman Street, Suite 200
clty Longmont state CO Zipcode 80501 Phone [phone]
Certification(Please refer to the Regulations and Application Submittal Package for complete application requirements.)
I certify that I am signing this Application Form as an owner of record of the property included in the Application.I certify that the information and
exhibits I have submitted are true and correct to the best of my knowledge.I understand that all materials required by Boulder County must be
submitted prior to having this matter processed.I understand that public hearings or meetings may be required.I understand that I must sign an
Agreement of Payment for Application processing fees,and that additional fees or materials may be required as a result of considerations which
may arise in the processing of this docket.I understand that the road,school,and park dedications may be required as a condition of approval.
understand that i am consenting to allow the County Staff involved in this application or their designees to enter onto and inspect the subject
property at any reasonable time,without obtaining any prior consent.
All landowners are required to sign application.If additional space is needed,attach additional sheet signed and dated.
Signature of Property Owner Printed Name John Heffernan Date z ZZ
Signature of Property Owner to Printed Name Date
Therese Glowacki May 3,2022
The Land Use Director may waive the landowner signature requirement for good cause,under the applicable provisions of the Land Use Code.
Form:P/01 •Rev.07.23.18•g:/publications/planning/p01-planning-application-form.pdf 1