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2. APPLICANT INFORMATION
4. First Name*
5. Last Name*
7. Company
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email Address*
20. OWNER INFORMATION
22. First Name*
23. Last Name*
25. Company
27. Address1*
29. Address2
31. City*
32. State*
33. Zip*
35. Phone Number*
36. Email Address*
38. CONTACT PERSON
40. Note

    The person listed as contact will be contacted to answer questions regarding this application, provide additional information when necessary, post public hearing signs, will receive a copy of the staff report prior to Public Hearing (if applicable), and shall be responsible for forwarding all verbal and written communication to applicant and owner.

42. First Name*
43. Last Name*
45. Address1
47. Address2
49. City
50. State
51. Zip
53. Phone Number*
54. Email Address*
58. Location of Request (address)*
60. Type of Action Requested*

    Check one or more of the actions listed below which pertain to your request.

    1. Rezoning
    2. Planned Development (ODP, SDP)
    3. Planned Building Group
    4. Temporary Use, Building, Sign

    1. Variance/Waiver (from Section 26-___)
    2. Special Use Permit
    3. Conditional Use Permit
    4. Site Plan

    1. Concept Plan
    2. Right-of-Way Vacation
    3. Subdivision (Type I)
    4. Subdivision (Type II)
62. Detailed description of request*
64. Certification

    By signing below, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that in filing this application, I am acting with the knowledge and consent of those persons listed above, without whose consent the requested action cannot lawfully be accomplished. Applicants other than owners must submit power-of-attorney from the owner which approved of this action on their behalf.

66. Signature

    
    

    __________________________________________________________

67. Date

    
    

    ____________________________________

69. PRINT & SIGN

    Please print and sign this application and submit it with your application materials. 

    
    

    NOTE: Notary is ONLY required for rezoning, ODP, and SDP applications.

71. Notary Block (only required for rezoning, ODP, and SDP applications)

    State of Colorado                   )

                                                       )    ss

    County of _________________  )

    Signed and sworn to before me this _______ day of _____________________, 20____, by the Applicant named above,  __________________________________________________. 

    My commission expires: __________________________

    
    

    _______________________________________________

    Notary Public

75. To be filled out by staff
    
    

    Date received                                         Comp Plan Design.                                   Fee $                                    Receipt No.                               

    Case No.                                                           Quarter Section Map                           Related Case No.                                                                     

    Pre-App Mtg. Date                                                      Case Manager                                                                                                                       

    Assessor’s Parcel No.                                                           Current Zoning                                    Current Use                                                  

    Size (acres or sqft)                                                Proposed Zoning                                       Proposed Use                                                          

Leave This Blank:


76. Print Only

* indicates a required field