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

Legal Description of Property:
• Subdivision:
Lot Block Filing Tract
• Section Township Range OR Attach a Metes and
Bounds legal description and survey depicting the property boundary.
• Mining Claim:
Street Address:
Assessor's Parcel No.
4 , `. . ' a~ ~ s~ Ks3rS-,;,rfia:}PRO' ECT D~°ATA- `. ~y ,' ty°.,a ~ . ~?~ N ,
Written Description of Project (attach additional information as necessary):
Current Zoning:
Current Land Use:
Access:
Source of Water (if in a District, provide name):
Source of Waste Disposal (if in a District, provide name):
Name of Fire Protection District:
Name of Electric Provider:
Name of Gas Provider:
Date Parcel Created for Exem lion Plat onl
Proposed Zoning (for Zone Change only):
I DO HEREBY CERTIFY THAT THE FOREGOING REPRESENTATIONS AND ATTACHMENTS ARE TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE.
Signature of Property Owner, Authorized Applicant, or
Authorized Agent or Representative
Date