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FLOOD HAZARD DEVELOPMENT PERMIT (FHDP) APPLICATION <br />FOR PLANNING DEPARTMENT USE DATE RECEIVED <br />--- -------- <br />RECEIPT/AMOUNT # /$ CASE # ASSIGNED <br />-------- ------ ----------------- <br />APPLICATION RECEIVED BY PLANNER ASSIGNED <br />Parcel Number 1313 16 0 - 00 - 010 <br />(72 tligii number - fountl on Taz I D m/orma0on, oblamaDle at the Weid County Assessor's Oflice. or www co weld co usl <br />Legal Descnpoon _NE 1/4 _________, Sectan 16, Township _?_ North, Range 68West <br />FEE OWNER(S) OF THE PROPERTY <br />Name. Mineral Resources, Inc~A SubsidarY of Lafarge West Inc. __ _ _ <br />work Phone # 303-657-4421 Home Pnone # _ 303-829-6511 Email Address suzannejanzen@lafarge-na.com <br />Address 1400 W. 64th AVP._ __ __ - ___ ___ <br />aty/state/zP Code __Denv_er, CO 80221 ___________ <br />APPLICANT O R AUTHORIZED AGENT (See Below Pufhone6on must acompeny allapplicaeors sgnetl oyAulhonzed Agent/ <br />Name Suzanne Janzen <br />work Phone # _ 303-65_7-4421 Home Phone # 303-829=6511 Email Address suzannejanzen lafa~na.com <br />address 1400 W. 64th Ave. _________ _ <br />City/State/Zip Code Denver CO 80221 _______ <br />General Descrip0on of Proposed Devebpment (Check when applicable) <br />Residential <br />NEw COn 51rW l~ui. <br />Addition or Improvements <br />In Subdrvision <br />Non-Residential <br />New Consiruunbn <br />Addition or Improvements <br />FJI Matenal <br />Manufactured of Mobile Home <br />On Sngle Lot <br />In Mobile home Park <br />FJI Matenal <br />Fill Material Watercourse Alteralan In Mobile Home <br />Su bdrvisgn <br />other Sand and Gravel Mining ____ _ <br />Briet NarraOve Description of Proposed Development Conveyor Crossing of Idaho Creek <br />3 Property located mdesignated FW (Floodway)District~ Yes No X (Ifyes, cer6hca0on shallbe <br />provided by a registered professonal engineer Thal the property use or structure, when built, will not cause any <br />increase in fbodwater levels tlurng an intermediate regionalflood (100-year fbod) or wit limit or restnct the flow <br />capacity of the floodw ay ) <br />4 ro r I ate designated FP-1 or FP-2 (Floodprone) Distnct~ Yes_ X No_ <br />Signature Owner or Authored Agent Date Signature Owner or Authorized Agent Date <br />(It an Autnonzetl Agent sigis, a letter of autnonmkon from all tee owners must be inUudeO witn the application 11 a corporation is the fee owner, <br />notanzed evidence must be included showing the signatory has to legal aulhonly to sign for the corporaum ) <br />-6- <br />