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1111111111111111111 <br /> SOLID W...., .,..,999.,n� of 1 <br /> USE BY SPECIAL REVIEW APPLICATION <br /> Department of Planning Services, 1400 N. 17th Avenue, Greeley, Colorado 80631 <br /> • Phone-353-6100-Ext. 3540 <br /> Case Number Date Received <br /> Application Checked By Mylar Plat Submitted <br /> Application Fee Receipt Number <br /> Recording Fee Receipt Number <br /> ------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------- <br /> TO BE COMPLETED BY APPLICANT: (please print or type, except for necessary signature). <br /> I(we), the undersigned, hereby request a hearing before the Weld County Planning Commission and Weld County Board of <br /> County Commissioners concerning the proposed Use by Special Review Permit on the following described unincorporated <br /> area of Weld County, Colorado: <br /> LEGAL DESCRIPTION OF SPECIAL REVIEW PERMIT AREA:Ny 4 Section 31 T 3 N. R 67 W. LEGAL <br /> DESCRIPTION of contiguous property owned which Special Review Permit is proposed: Section _T N. <br /> R W. <br /> Property Address(if available) 12910 [bld Oaxlty W. 13, Lalrnait, O) 80504 <br /> PRESENT ZONE Aorjulibnai OVERLAY ZONES Flood Fjazacd TOTAL ACREAGE 129 <br /> PROPOSED LAND USE AQdr111 iral EXISTING LAND USE_�grj^mil i�xal <br /> SURFACE FEE (PROPERTY OWNERS) OF AREA PROPOSED FOR THE USE BY SPECIAL REVIEW PERMIT: <br /> Name: Varca Oatparies Inc <br /> Address: 12910 1L-1d Oarlty W. 13 City: Lar ait, a) Zip: 80504 <br /> it Telephone: Business Telephone: 303.666.8269 <br /> .,ame: Address: City: Zip: <br /> Home Telephone: Business Telephone: <br /> APPLICANT OR AUTHORIZED AGENT(if different than above): <br /> Name: Jab✓ Adms of 03;S DC. <br /> Address: P.O. Bic 1489 City: Fbrt Ca im, Q7 Zip: 80524 <br /> Home Telephone: Business Telephone: 970.493.7780 <br /> List the owner(s) and/or lessees of mineral rights on or under the subject properties of record. <br /> Name: Marra rl-nr' JR; Trr --- -- <br /> Address: lxnn yhia a-,xty sal- n City: Tcpy,rnr, m Zip: 80504 <br /> I hereby depose and state under the penalties of perjury that all statements, proposals and/or plans submitted with or contained <br /> within the application are true and correct to the best of my knowledge. <br /> A � law— <br /> Signatu : Owner or Authorized Agent <br /> REVISED: July 25. 1996 <br />