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Moffat County Planning Department <br />221 West Victory Way, Suite 110 <br />Craig, CO 81625 <br />(970) 824-9148 <br />APPLICATION FOR CONDITIONAL USE <br />rg7b) a-Inn" <br />Address: <br />Landowner:67DZ ?17 )Y-anL _ Phone: Home-Business-Cell: <br />Address: <br />Agent, if any <br />Address <br />Home-Business-Cell: <br />Acreage: <br />Legal Description and Driving Directions: <br />Proposed Use (Describe in <br />LeV, !' o r <br />bnt uire4 Tfvah, jDo+C) Art{ IS?UC? Ott" ? C, ?pondP <br />Proposed Starting Date: '7- ) - 2n%% Proposeedd Completi Date: <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 system: Public ( ) Private ( ) Existing ( ) <br />Indicate type of sewage system: Public ( ) Private ( ) Existing ( ) <br />Indicate any plans for buildings and structures (permanent or temporary) to be located on this land. Include any <br />applicable site plans and elevation plans. <br />Include a man. drawn to scale. showing the general location of the Property, the location of the proposed <br />use. the existine and proposed roads and easements, and the names and mailing addresses of adjacent <br />property owners The may should include at least a 200 foot Derimeter and show access to the property <br />from a public road. C, <br />Applicant / Agent Signature: Date: - 1 - b <br />Landowner Signature: (-)7 Date: -'I ? Or copy of lease contract. <br /> <br />NO. C- <br />Fee: $200.00 <br />Date Paid <br />The 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.