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221 Wear ,y <br />Craig, 81ot~ <br />n) ~ezzl <br />~- <br />Fee p75.00 plus <br />• postage <br />Data Paid <br />APPLICATION FOR CONDITIONAL USB <br />Applicant: 4~or-~ AT ~~.JT~ "120~~ ~,pT. Phonet AZS[. -!RZl I <br />Addreea: two. I3oY (el..~ <br />Landowner: ~AFTOPa ~I ~o S ~lLOTi1E c Phonet_t~i ZSL - 290 fi <br />Addreea: 43'/'i STo~ i ST .2a: _ t? c~ 9CG LS <br />Agent, if any: Meat./. , ~ M o 0 2~ Phonet G ~yL - 9 =-4~9 <br />Addreeet /S 70 2ei,J wJ ~'-1 ~1T_.o_ LG, t ~ Fi 1 L -ti <br />Acraegat 70 AC2a? S Zonadt A <br />Legal Description s L aT ~ Z ~ r 5 L.[-' Tj o til 9 , '"L-i 1 tJ~ <br />R 9 S uJ o.= L T~' P. nn . <br />Proposed Use (Describe in Detail) s Gl2A/E.L Ivt ~ wJ E. <br />Proposed Stetting Datet~J...t~ roposed Completion Dates 'Sa._tG~.~OO45 <br />Attach copies of state and/or federal permit applications, if applicable. <br />Attach copies of state and/or federal reclamation bonds, if, applicable. <br />Indicate type of water eyetemt Public ( ) Private ( ) Bxieting ( ) <br />Indicate type of sewage eyetemt Public ( ) Private ( ) 6zisting <br />Indicate any plane for buildings end structures (permanent or temporary) to <br />located on this land. Include any applicable Bite plane and elevation play <br /> <br />Applicant/Agent 8lgnaturet <br />Landowner Signatures <br />Datat ~~'.`' /~ <br />Dater ~~~~~~~~ <br />The above signing ereby authtiriza^ the Notfat County Commiuioners or tt. <br />designate, to cond 't an of-site inspection of the property described hat <br />when necessary to make an informed evaluation of the proposed conditional ~ <br />no... nt CoF <br />