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~ .. <br /> <br />CONDITIONAL USE PERMIT APPLICATION <br />CHE'lENNE COUNTY <br />Number (? ~ -- (ti~i <br />Date ~,~ 'L / -~? <br />71 F N ^~-~ <br />Owner <br />Mai <br />Pho <br />Contractor <br />Mailing <br />Phone nu <br />S[=~~~[[ u <br />Legal description of 1a~ld ~/G'tu-l-- <br />State of Colorado <br />Fee <br />Fn 1 <br />Land is presently zoned <br />Intended use ~~-.ie.'~,r I.GC• S rcl ~~'ceuc~ ~ p~ ~ <br />Class of work: ~ New Addition Rlteration <br />w <br />Repair Move <br />Changing use from <br />Changing use to /~~ <br />Approximate valuation of work <br />Size of building <br />Lot size f L~ /E r_re s <br />water source /L'/.~y <br />Sewer facilities i(.~/~i- <br />Required setbacks: Front Side <br />Rear Side <br />Special conditions: <br />Public hearing held on 1[~ev .2 n -- ({ m - ;? ~ P/i1 <br />(Date) <br />