GENERAL38826

• Permit No: M2003030
• IBM Index Class Name: General Documents
• Doc Date: 6/4/2003
• Doc Name: Conditional Use Permit needed
• From: Teller County
• To: Joseph L. Dorris
• Media Type: D
• Archive: No

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LAND USE APPLICATION FORM
Teller County Comr+iunity Development Services
PLANNING DEPARTMENT
Post Office Box 1886 t7 Woodland Park, CO 80866
[phone] ~r FAX: [phone]
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^ 1041 ^ Sketch Plan (Subdivision)
^ Conditional Use Permit ^ Special District
Use Requested: ^ Subdivision Exemption
^ Variance Permit

^ Final Plat ^ Vacation: Lot Line
^ Location & Extent ^ Vacation: Other
^ Minor Subdivision ^ Zone Change
^ Preliminary Plan (Subdivision) ^ Other:
^ PUD (Sketch or Preliminary)
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Name:
Mailing Address:
IF MORE THAN ONE PROPERTY OWNER, ALL PROPERTY OWNERS MUST BE LISTED
(attach list)
Phone OFFICE: HOME:
FAX: a-mail
^ COMMITMENT FOR TITLE INSURANCE, TITLE COMPANY OWNERSHIP & ENCUMBRANCE
REPORT, OR DEED/S ATTACHED
Name:
Mailing Address:
Phone OFFICE: HOME:
FAX: a-mail
^ WRITTEN AUTHORIZATION FROM ALL PROPERTY OWNERS FOR APPLICANT TO SUBMIT THIS
APPLICATION ATTACHED
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