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? o1Oka i (6 'gA???? Ot, <br />SOURCE OF WATER: Please indicate how water will be provided for the subject property. <br />? Public Water Source - District Name: <br />?Private Well - Attach Well Permit <br />? Water Shares - Attach Letter <br />SEWAGE DISPOSAL: Please indicate how sewage disposal will be provided for the subject property. <br />? Public Sewage System - District/Town: Ald*a N, W_? <br />? Individual Sewage Disposal System (ISDS) --Permit # <br />? Existing System - describe: <br />TRAFFIC EXPECTED TO BE GENERATED BY THIS CHANGE:, „? 2Q.Ag-_ <br />1:: 11110ii <br />ACCESS: Please select one of the following: <br />? Colorado Department of Transportation Highway Access Permit # <br />? Conejos County Access Permit # <br />? Existing County Access fit' n 2 rs <br />--- The following documents must also be attached/included with this application. - - - <br />? CERTIFICATION OF TAXES PAID: Attach the County Treasurer's certification of taxes paid. <br />? VICINITY MAP - 8 %i x 11" copy of an aerial photo locating the section in the County in which the parcel is located. The <br />boundaries of the subject property shall be indicated on the photo. <br />? SITE PLAN - Complete the attached site plan that best conveys the conceptual aspects of the plan and for effective public <br />presentation. <br />0 SURROUNDING LAND OWNERS WITHIN 500 FEET OF THE SUBJECT PROPERTY - Provide a list of the surrounding <br />landowners. <br />? SURVEYED PLAT - In the event that a surveyed plat is required the following basic standards must be met in addition to any <br />other requirements for a specific application. Section 3.210 B. Additional Information Required -attached requirements. <br />? SLOPE/TOPOGRAPHIC MAP - A depiction of contours at an interval of five feet is required on slopes of 15% or greater (13.5 <br />degrees) where there will be a permanent change in elevation of the ground surface. This requirement may be met by providing the <br />best mapping available from the US geological Survey highlighting areas of geologic hazards, and areas subject to landslides and <br />avalanche. <br />? ARCHAELOLOGICAL, CULTURAL AND HISTORICAL RESOURCES -If appropriate one of the following will be <br />required: A letter of verification of a search of Inventory of Cultural Resources from the State historical Society or a report defining <br />the archaeological or historical resources on the site based on information available from the State Historic Preservation Officer. <br />? WILDFIRE MITIGATION PLAN - The applicant may be required to create a wildfire mitigation plan with the assistance of the <br />State Forest Service, if appropriate. <br />2 IMPACT ANALYSIS - A description, prepared by the applicant, of the impacts that the proposed use may cause, described in <br />terms of the standards that apply to Special Uses in Section 5.500 - STANDARDS OF APPROVAL, and a complete description of <br />how the applicant will ensure that impacts will be mitigated and standards will be satisfied. <br />? ADDITIONAL MATERIALS - The Land Use Administrator requests the following additional materials: <br />Special Use Review 03-2009 2