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.~. <br />j ~~~ ~~~~~~I~~~'~~II~ <br />C! 071 ~ sss ~~~ <br />U U ~~ <br />~, .... .. <br />l3UULUEH CVUNI Y LAND' USE UEPAH TMENT ~XBMB'r.,~, r.r A• , t `~ <br />~ " <br />l/ <br />2045 13th Street) 13th & Spruce Streets / Courthouse Annex <br />O <br />B <br />477 <br />B <br />ld <br />l <br />- P <br />C <br />d <br />60306 , <br />^ <br />~` <br />. <br />. <br />ox <br />/ <br />ou <br />er, <br />o <br />ora <br />o <br />• • <br />• (303J 441-3930 (fax 1303) 441-4656 ~ ~(~-~ <br />r <br />~ <br />'wf d <br />~ <br /> ~'S'Pi~ <br /> <br />APPLICALTION FORM y~/o <br />686 <br />,L <br />8 <br />•. 0 N <br /> <br />APPLICATIION pEADLINE n <br />A <br />0~ <br />FIRST WEDNESDAY OF THE MONTH - 4:30 <br />Does not eply to Exemption Plats <br />Site Plen Reviews , 1~~ <br />~ ~- y <br />~ <br />, <br />, <br />Limned Impact Special Reviews, or Subdivision Exemptions ~";, <br />~ <br /> .-pF ... <br />t:K-.n .~ <br />O BOA VARIANCE/APPEAL O REZGNING O SUBDIVISION SKETCH PLAN O OTHER. <br />O EXEMPTION PLOT O ROAD NAME CHANGE O SUBDIVISION PREDMINARY PLAN <br />O LIMITED IMPACT O SITE PLAN REVIEW O SUBDIVISION FINAL PLAT <br />O LOCATION 8 EXTENT • SPECIAL USE/SSOP O VACATION <br />0 RESUBDIVISION (REPEAT) O SUBDIVISION EXEMPTION <br />LOCATION(S) ~ STREET ADDRESS(ES) <br />S ~~ ~ (b. ~ R ,A- <br />~ facG~ ed. <br /> <br />SUBDIVISION NAME <br />S~'ec~rn bo~-~ `vQ~l~ <br />LOTIS) BLOCK(S) SECTION ) TOWNSHIP(S) ~ \ RANGE($~ <br /> ~ <br />APEA IN ACRES EXISTING 201VING E%ISTING uSE OF PROP RTY NUMBER OF PROPOSED LOTS <br />9r cc ,cc~l r~ fonP uctrl,y~ Z <br />PROPOSED WATER SUPPLY PROPOSED SEWAGE Di$ OSAL METHOD <br /> <br />APPLICANTIPROPERTVQWNER 1 STREET ADDRESS <br /> <br />CI h <br />~ <br />~ O ~ ~ <br />$ <br />TATE~ ZIPC~ <br />~ ~ ~ PHO~ E~U ~ <br />~~ - <br />~ <br />~ <br />~ ~ <br />' ~ <br />A <br />% <br />NUMBER ~ ~ ` ~ <br />~ ~ ' <br />r'1C'N` <br />CJ <br />9 <br />APPLIICANTIFgpC TY~W <br />` C <br />C' ^, <br />N <br />/ e I I ~ <br />r1- <br />C ~ <br />R <br />~ <br />~ <br />R ^ <br />.p ST~ <br />~ <br />p <br />~ <br />/~ <br />I' <br />o <br />/ <br />~ <br />~ <br />~ ~ wl <br />A <br />~S <br />I <br />. V <br />1~ <br />V 1 O 'e <br />r <br />II'- NUJ <br />,-l 'h <br />~n <br />d ~.-6 <br />/ <br />/~ D <br />I <br />/ <br />CI $T TE P'OD BER <br />ONE FAX NUMBER <br />C• 2 ~ DDS D) ~IL7 " - ~ I <br />APPLICANT/PROPERLY OWNER $iREEi ADDRESS I <br />CITY STATE ZIP CODE ~ PHONE NUMBER FA%NUMBER <br />APPLICANT/PROPERTY O WNER STREET ADDRESS <br />CITY STATE ZIP CODE PHONE NUMBER FA%NUMBER <br />APPLICANT/PROPERTY OWNER STREET ADDRESS <br />CITY STATE ZIP CODE PHONE NUMBER F//A%NUMBER <br />l <br /> <br /> <br />I certify that the Intormatlon antl axhl6lis I have submlttetl are Irue and correct to the best of my knowledge. In Illing the application I am acting with Iha knowledge <br />end consent of those persona who ere owners of the euhJecl property or ate pontes to ih{s application. I understantl That all materials requlretl by 6oultler County <br />must be subminad prior to having thb molter proctrasetl. I untlerstentl that public heeringa ar meetlnpa maybe requlretl. I understantl that atltlitionel lees or <br />malarlala may be requlretl ea a result o/ oonslderatlPns which may arise In the proceasing of thla docket. I understantl That iha roatl, school and park dedications may <br />he required ea a contlltlon of approval. <br />I untlersland that I am consenting to allow the Cowtty Steil Involved In this eppllcatlon or their designees to enter onto antl Inspect the sub)ect property at any <br />• raeaonable time, without ohlelning any prior <onsenl. <br />SIGNATURE DATE <br />X <br />SIGNATURE ,. DATE <br />X ~ <br /> <br /> a <br />• PLEASE REFER TO THE REGULATION: AND APPLICATION SUBMITTAL PACKAGE FOR COMPLETE APPLICATION gEOUIREMENTS • <br />~ PI FCCF CFF RGf:K • <br />