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~r.. ~; ~'R, ~„:: .:~_ ;c., `~'+ .._t `.+. h' COSTILLA COUNTl~ ' _ CANNING & ZONING DEPAh.~VIENT Application No. 1710 1'7~) o I G t-I Application Fee: $25.00 NOTE: If applicmtt is no[ the rnvtter of the property, then a copy of a corrtrac~ for sale or lease betx~eert applicant rnrd owner, or a trolari~ed letter front the rnvner torts rttirtg to llris application must be submitted. Applicant: ~qTT~/F ~'1~~u~rTc/i~ t r C~~P ~1./ vG ~ 5 ~ +,~owner: _n Address: iN, n ~ j'S~;)! ~ t (7 city +'~state~ape de fs 1/~z Address ojProposed Development . Phone N: 7 1 %- ~, '7 2 - ~i~/~ z Faxes: ~ 3 - 3 Legal Description of Land: (Attach a copy of deed of survey plat. Applicati ~n will be incom ate if not included. * In your awJJ words, pleyse describe the type o develpp ant propose CCN sTruc7 ~'r'P rtrhv,r;,T~r~ ~EC~I L7~_Ld.tr LG •X~t 7h A~ of ~ I I h o ~ s c~ c/ ~i~r7`cw~ 7`vcrs7r.? E ,~l"~•-~ ~5c PER1FfITSREOU/RED: (AS determined by the Land Use OII'ice) Individual Sewage Disposal System Grading `New Residential _Road Access Remodel/Expansion _Conditional Use Manufactured Home Placemegt Occupancy Accessory Bldg. (over 10x12 sq. ft.) ~,Othrr ' ~~ Note: A site plan will be required with this application along with rrrfditia al ntutchments for each permit thnt the I,mtd Use ice delernrines is needed jot the proposed development activity. Zoalssg (Ftli OfllCe 1s5e Only) Estate Residetrtia] (ER)^ Rural Residetrtial (RR)_ Agricultutfal (AG)_ Business & Commercial (BC), Light Industrial (LI)` General ]n al (GI)_ Watershed Protection District (WPD)_ Flood Hazard Overlay District FHOD), Watershed Protection District Review~N_ 1'loodplaio kiazard Rerliew_Y_N_ Staff Comments: ACKIVOWLEGMENTS If a pes~lt(s) is Issued pvrsuavt to this appantlon, she terms avd medlslovs of the It(s) shwa be based ov she Ivformatlov prgvlded by the appacavL Chavges )n the use of the permitted actlal es [hat are vot eoeslsuvt with the [cram and covdltlovs of the pergilt(s) or this applltxtlga may be tonsideted } ddadov of the PK~Ks} The appllnvl hereby declares that ell the Ivformatlon prodded ov ibis apptlcatloq a avy submitted athehmevt(a) for the purposes of obtilolug i permit, •re correct avd snmpleta The appawvt ckvoviedges that prveldlvg falx Ivforvtadov W • gvvemtvevt agevcy b pgvlshable as perJury In the secovd Jegrte, as well as bdvg puvlshable uvder aqy otherr a oNe stale or kdenl ll~aws Applicant's Signature / \ G .os~~°i .~~/n/11 ~ dato ~/ 2 7/ ~ RECEIV date eived By /~ ~I ,-, Approved• ,/,--~/~ /'l' /i ~ date ~ ,,,,,~ lady Land se Admi strator revised Dimsron of Minerals & Geob9Y 1999 ~l ~' - d ` _