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Moffat County Planning Department NO. C- <br />221 West Victory Way, Suite 110 Fee: $200.00 <br />Craig, CO 81625 Date Paid_ <br />(970) 824-9148 <br />APPLICATION FOR CONDITIONAL USE <br />Address: <br />Legal Description an~Driving <br /> <br />r <br />Use (De$cribe in Detail): ~/e~yJS <br />Proposed Starting Date: ] - ~ ~~' Proposed Completion Date: ~~~- <br />Attach copies of state and / or federal permit applications, if applicable. `,, A~,AAi ~ l~n <br />Attach copies of state and / or federal reclamation bonds, if applicable. ~" U i"i'` l/ <br />Indicate type of water system: Public ( )Private ( )Existing ( ) ~'~~~~~ ~~~ <br />Indicate type of sewage system: Public ( ) Ppv ( ) Exis ing ( ) ~~j,!'~,~ <br />Indicate any plans for buildings and struct es (permanent or t~ orary) to be located o~'n t~h°is land. Include any <br />applicable site plans and elevation pharts. <br />Include a map, drawn to scale, showine the eeneral location of the property, the location of the proposed <br />use, the existing and proposed roads and easements, and the names and mailing addresses of adjacent <br />from a public road. <br />Applicant /Agent <br />Landowner Signature: <br />llate: <br />Date: <br />:h copy of lease contract. <br />.~ ~~~~m~~ ~D <br />fhe above signing hereby authorizes the Moffat County Commissioners or their designate, to conduct an off- <br />site inspection of the property described herein when necessary to make an informed evaluation of the proposed <br />conditional use. <br />Landow-rter: V. L~ICal.iSg J-f~tl4LU1'hone: Home-Business-Cell: (~/ ~fl) ~U"'~~SG 1 <br />Acreage: ~~ Zoned: ~j'.,~/(' _ <br />