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FOR PUBLIC WORKS DEPARTMENT USE DATE RECEIVED: <br />RECEIPT /AMOUNT # /$ CASE # ASSIGNED: <br />APPLICATION RECEIVED BY PUBLIC WORKS REVIEWER: <br />Parcel Number: Multiple Parcels - See Attachment _ <br />Waterway Name: Cache La Poudre River Flood Insurance Rate Map (FIRM) Panel #: 080266- 0637 C <br />Legal Description Multiple Descriptions - See Attachment , Section , Township _ North, Range West <br />FEE OWNER(S) OF THE PROPERTY: <br />Name: Varra Companies, Inc. <br />Work Phone # 303 - 666 - 6657 Home Phone # 720- 272 -2857 Email Address gcvarravci @aol.com <br />Street Address: 8120 Gage Street <br />City /State /Zip Code Frederick, Colorado 80534 <br />APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany all applications signed by Authorized Agent) <br />Name: Garrett Varra <br />Work Phone # 303- 666 -6657 Home Phone # 720 - 272-2857 Email Address gcvarravci @aol.com <br />Street Address: 8120 Gage Street <br />City/State/Zip Code Frederick, Colorado 80534 <br />1. General Description of Proposed Development: (Please check all that apply) <br />Residential Non - Residential Manufactured of Mobile Home <br />❑ New Construction ® New Construction ❑ On Single Lot <br />❑ Addition or Improvements ❑ Addition or Improvements ❑ In Mobile Home Park <br />❑ In Subdivision ❑ Fill Material ❑ Fill Material <br />❑ Fill Material ❑ Watercourse Alteration ❑ In Mobile Home Subdivision <br />Other <br />2. Brief Narrative Description of Proposed Development: Open Cut, Dry Mine Gravel Quarry <br />3. Property located in designated FW (Floodway) District? Yes X No (If yes, certification and <br />engineering calculations shall be provided by a registered Professional Engineer (P.E.) that the property use or <br />structure, when built, will not cause any increase in floodwater levels during an intermediate regional flood <br />(100 -year flood) and will not limit or restrict the flow capacity of the floodway.) <br />4. Is the property located in a designated FP -1 (100 -yr Floodplain) or FP -2 (500 -yr Floodplain) District? <br />Yes X No <br />Signature: Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date <br />(If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, <br />notarized evidence must be included showing the signatory has to legal authority to sign for the corporation. ) <br />Updated 03 -13 -2008 <br />FLOOD HAZARD DEVELOPMENT PERMIT (FHDP) APPLICATION <br />(12 digit number - found on Tax I.D. information, obtainable at the Weld County Assess or's Office, or www.co.weld.co.us). <br />6 <br />