PERMFILE52567

• Permit No: M1994080
• IBM Index Class Name: Permit File
• Media Type: D
• Archive: No

_"`-'"='"'~ Lorimer County Planning
Application Form
^ Misr Residerttlal Devebpment
^ Minor Land Division
^ Amended Exerrtptbn
^ Boundary Llne Adjustment
^ Add - On Agreement
^ Vacation of ROW /Easement
^ Street Name Change
THIS APPLICATION IS FOR:
Type of Application
(Check All That Apply)
^ Land Use Plan Amendments
^ Resolution amendments
^ Amended Plat -Subdivision
^ Sketch Plan /Concept Review
^ PUD Master Plan
^ Preliminary Plat - Subdivison
^ Final Plat -Subdivision
^ Recording Plat - Subdivisbn
^ BOA -Zoning Variance
^ BOA -Special Exceptbn
^ BOA - Appeal of Stall Decisbn
^ Rezoning
Special Review
^ LOCatbn and Extent
^ CTR ^ PLANNING COMM. ^ UGA REVIEW BRD ^ BOARD OF ADJUSTMENT ^ BOARD OF COMMISSIONERS
Previous File Number: (STAFF WILL FILL IN1 Cholce
General Information
P~
Name
Address: SgnS ~Le 2 a Z'~
City/State2ip: h o v e l rt ~; a C o l a $ o S 3 8
Phone:(H)(nlo'3- 192b (W) (oto3' 141.0
Prone Owner:
Name:
Address: _
Crty/State2ip:
Phone: (H)
Property Owner:
Name:
(~
Address:
City/State2ip:
Phone: (H) (W)
ARpllr~nL'
Name: er(~[~,.lrs h') Sr~raar.e
Address: S q ~ S (v C.2 t1- 17
City/State2ip: L ., ~.~.I a n d Colo $ r) S 3 8
Phone: (H) to to'j- 14 20 (W) (o Lo 3- l q 2D
EO-IDEEL:
Agency: N
Contact Person:
Address:
Crty/State2ip
Phone:
Surveyor:
Agency: N !}
Contact Person:
Address:
City/State2ip
Phone: ( )
^ Plannlna Consultant:
Agency: .y /~
Contact Person:
Address: _
Clty/Stale2ip
Phone:
Signatures
lherebyaertiythat I emthe lawfulownerdthe peroegs)of Iandvrttichtltis apQfimtioncartoemsandcorcerdtoOtisaction. Thereby permitoounty
otTidals to enter upon the property forthe purposes of inspection relemng 1D the application. Plwaa Nob: Buldng Parmlta pR1ot ba Iswwd
wh0e 1Ns applke(lon ~ P~tII,
herebycertify Cratthe erformafion and §xhbits tfdrewilh s~miCed are true and conecttothebestof myknowledge and that in filing the application
I am acOng with the knowledge and corsent o}the owners of fhe property. I urdsrstand and agros that lhla proposal mey ba delayed In
procassktg H the lydormatfon provldad is ttcanplsb, Inacetrale, or submitted agar Un stbrnktal daadOna.
Mp+~
PLEASE NOTE SUBtrfTTAL DEADLNES: Applintbro submitted after 1290 pm on sulxnlltal dssdlha days will not ba socapbd.
Plaaaa oampMta sactbns on the nvaras aide.
Fie • Rm Check •
Amount Paid S
Sign Given
LCAZ 705 1092