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~ Proposed Water Supply: '~ Proposed Sewage Disposal System ~ <br />j N/A ; Sani~Serv or equiv. <br />j Existing Solid-fuel Bumer N/A ;Proposed Solid-fuel Bumer N/A I <br />i I hereby certify, subject to penalty of perjury, that the above is true and accurate to the best of my i <br />j knowledge and that I understand all provisions of County and State codes applicable to the proposed <br />development, any and all conditions placed upon the proposed development by the Board of County <br />Commissioners and all information requested by this document. I also understand that if I violate any <br />j applicable provisions of County and/or State codes, I may be required to remedy such violation(s) <br />through appropriate legal process imposed by the County, including moving or removing structures <br />j and ceasing Of construction and/or uses. i <br />Pathfinder Developme t, Inc. <br />By: Date- <br />Scott Smith, President <br />Applicant's Phone: <br />9T0-728-3403 <br />Applicant's Fax: <br />970-728-1316 <br />Applicant's Email: <br />s_smith(rDtelluridecolorado. <br />net <br />Name and signature of Applicant <br />[xl <br />._.. .. <br />[x) <br />Site Prep <br />Excavation/Utilities <br />[ ] ~ Building Plan N/A <br />[ ] .Addition/Remodel N/A <br />[ ] i Septic N/A ~ [ ] .Access. Structure NIA <br />__ ~ _... <br />I-- -. _..... _ _... <br />[ ] I Foundation NIA i [ ] i Other <br />2. PLANNING DEPARTMENT SHALL VERIFY COMPLIANCE WITH: <br />Application Completeness _ (If incomplete, return to applicant) <br />Zoning :Affordable Housing <br />Area/Activ'ity of State/Local Interest: <br />Floodplain <br />i Should Building Permit Application be considered? !Yes ~ No i <br />C:\Documents and Settings\,AdministratorUvly Documents\dev.permit.form RR R.O.W..doc <br />