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D. APPLICANT AND LANDOWNER SIGNATURES: <br />The undersigned applicant and landowner hereby verifies and affirms that the <br />information contained in this application is complete and accurate. The undersigned <br />applicant and landowner understands and acknowledges that the submission of inaccurate <br />and incorrect information may result in the denial or rejection of the application and/or <br />result in the invalidation of any approvals issued by Park County, Colorado. <br />Applicant: Signed: <br />Print name: <br />0.,ktA' <br />If company, state Title/Position: a tn� <br />E. VERIFICATION OF DATE OF DELIVERY OF APPLICATION <br />This application was submitted to the Park County Planning Department on the following <br />date and time: <br />19 10 <br />Month U Day Year <br />Payment of the Applicant Fee was made by: <br />Personal Check # 3bg Amount $ 5176 , vU <br />Cash Amount $ <br />Other Amount $ <br />For County Use Only: <br />Verification of Date of Delivery and <br />County Recei of A. ' lication <br />Date: • <br />Print Name <br />APPLICANT MUST ATTEND THE HEARING. IF A REPRESENTATIVE <br />ATTENDS THE HEARING ON BEHALF OF THE APPLICANT, A NOTORIZED <br />LETTER OF CONSENT MUST ACCOMPANY THE APPLICATION. <br />ALL PLANNING COMMISSION HEARINGS WILL BE SCHEDULED FOR <br />THE SECOND TUESDAY OF EVERY MONTH. IF A QUORUM IS NOT <br />AVAILABLE, THE HEARING WILL BE SCHEDULED THE NEXT <br />AVAILABLE DATE. <br />Pagc6of8 <br />Conditional Ilse Permit — Revised 2/10 <br />