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_"`""'°=°'= Lorimer County Planning <br />Application Form <br /> Type of Application <br /> (check All That Apply) <br />^ Minor Residential Development ^ Land Use Plan Amendmerns ^ Recording Plat -Subdivision <br />^ Minor Land Division ^ Resolution amendments ^ BOA -Zoning Variance <br />^ Amended Exemption ^ Amended Plat -Subdivision ^ BOA - Special Exception <br />^ Boundary Line Adjustment ^ Sketch Plan /Concept Review ^ BOA - Appeal of Stott Decision <br />^ Add - On Agreement ^ PUD Master Plan ^ Rezoning <br />^ Vacation of ROW /Easement ^ Preliminary Plat -Subdivision ® Special Review <br />^ Street Name Change ^ Final Plat -Subdivision ^ Location and Extent <br />THIS APPLICATION IS FOR: <br />^ CTR lSl PLANNING COMM. ^ UGA REVIEW BRD ^ BOARD OF ADJUSTMENT ^ 80ARD OF COMMISSIONERS <br /> Previous File Number: (STAFF WILL FILL IN) Choice <br /> <br /> General Information <br />Property Owner: <br />Name: Alexander B . $ Sandra j~Qp(pg~; <br />Ai. Grant Agency: Tuttle Applegate, Inc. <br />Addres5:4308 East Co~mty Road ~3(i CornactPerson: John Jordan <br />City/State2ip: >;o,-r rntt;~ic rn RnS~S Address: lt4nn rra„r Straat e„y~ ain <br />Phone: (H) (W) City/State2ip T>Pnver, CO 80233 <br />Properly Owner: Phone: (303) 452-661] <br />Name: Survgyor; <br />Address: Agency: <br />City/StatelZip: Contact Person: <br />Phone: (H) (W) Address: <br />Property Owner: City/State2ip <br />Name: Phone: ( ) <br />Address: ~] Designer: <br />CitylState2ip: ~] Plannlnp Consultant: <br />'Phone:(H) (W) Agency: Tnrrla A~tPif~P r.,~-_ <br />18R.p (cant: Contact Person: Iohn Jordan <br />Name: Connell Resources, Inc. Address: 11990 Grant Street, Suite 410 <br />Address: 4305 East Harmony Road CitylStatelLip~nver, CO 80233 <br />City/State2ip: fort Collins, CO 80525 Phone: (303) 452-6611 <br />Phone: (H) (W) ( ~~- <br /> Signatures <br />I freretry certify that I am the lawful owner of the parcel(s) of land which this application conoems and consent to this action. I herefry permit county <br />officials to enter u e property for the s of inspection relating to this application. Please Note: BuOding Permlls carrot be issued <br />while this r Is pendl <br />Owner <br />Iherebycertifytha ein rmati an x i rewithsubmittedaretrueandconecttothebestofmyknowledgeandthatinfilingtheapplication <br />' I am acting with the knowledge and co nt of the owners o(ihe property. I understand and agree that this proposal maybe delayed In <br />processing q the IMormaNon ided I <br />~ s Incomplete, Inaaurate, ar sutxnitted after tha submittal deadline. <br />Applicant: ~ <br />- "~ <br /> <br />r PL1=,4SE NOTE SUBMTTAL DEADLINES: AppllCatbns submNted otter 12:00 pm on aubmNtat deadline days will not be accepted. <br />Please complete sactbns on the reverse side. <br />~# <br />RID <br />Chedcp <br />Amount Paid $ <br />Sign Given <br />i cap me ,mob, <br />