HomeMy WebLinkAbout1.0 Application.pdf)
GARFIELD COUNTY RE(1F:J v ~D
Building & Planning Department DCC 2 8 200 ,,
108 81h Street, Suite 201 t
Glenwood Springs , Colorado 81601 c. ' ' l 1 , , , /
Telephone: 970.945.8212 Facsimile:897o :3 84 .3tl7P . "'-'
www.garfield-county.com
Conditional Use Permit
GENERAL INFORMATION
I ~IT
~ Street Address I General Location of Property:___j..L...L..::.L_J__~~~::::_L!.~~.:::.....w~
,-[-~ c-,e.. 1~1 1 frif S'jXttA-f(
~ Legal Description: P~~ ;(/~--Jo J.-OD -/0 '-
5 3 D I f (, S I R. ftt u--)
~ Existing Use & Size of Property in acres : 3 C ft e-oVu
~ Description of Conditional Use Requested : .£rwiJ2~ ~ &uf-'
);> Zone District: A-R --/?_f)
)> Name of Pro :rtv Ownero licant: #~ ~ "DAAC!.~ ~ Address : CJ /_/, C> cAJ~ /bl]. Telephone:(/)~, 9'1./7, :33'j'
~ City)ikw,J~~ State : ~ Zip Code : 7/6o/ FAX : 9'Ai=-/'/3'J
~ Name of Owner's Representative, if any (Planner. Attorney. etc):
~ Address: _____________ Telephone: ______ _
~ City: ________ State: ___ Zip Code: FAX : ___ _
STAFF USE ONLY
~ Doc. No .: _____ Date Submitted : ____ TC Date: _____ _
~ Planner: Hearing Date: _________ _
~'-~ .K' APPLICATION SUBMITTAL REQUIREMENTS
As a minimum, specifically respond to all the following items below and attach any additional information to
be submitted with this application:
1. Submit plans and specifications for the proposed use including the hours of operation, the
number and type of vehicles accessing the site on a daily, weekly and/or monthly basis, and
the size of any existing and/or proposed structures that will be used in conjunction with the
proposed use. Please submit the specific information in narrative form and be specific.
2. If you will be using water or will be treating wastewater in conjunction with the proposed use,
please detail the amount of water that would be used and the type of wastewater treatment. If
you will be utilizing well water, please attach a copy of the appropriate well permit and any
other legal water supply information, including a water allotment contract or an approved water
augmentation plan to demonstrate that you have legal and adequate water for the proposed
use.
3. Submit a site plan /map drawn to scale that portrays the boundaries of the subject property, all
existing and proposed structures on the property, and the County or State roadways within one
(1) mile of your property. If you are proposing a new or expanded access onto a County or
State roadway, submit a driveway or highway access permit.
4. Submit a vicinity map showing slope I topography of your property, for which a U.S.G.S.
1 :24,000 scale quadrangle map will suffice.
5. Submit a copy of the appropriate portion of a Garfield County Assessor's Map showing all
mineral rights owners of the subject property and public and private landowners adjacent to
your property. In additional, submit a list of all property owners and their addresses adjacent to
or within 200 ft. of the site. This information can be obtained from the Assessor's Office.
6. Submit a copy of the deed and a legal description of the subject property.
7. If you are acting as an agent for the property owner, you must attach an acknowledgement
from the property owner that you may act in his/her behalf.
8. Submit an impact statement that specifically responds to each of the following criteria from
Section 5.03 of the Zoning Regulations:
(1) Utilities adequate to provide water and sanitation service based on accepted
engineering standards and approved by the Board of County Commissioners shall either
be in place or shall be constructed in conjunction with the proposed use.
(2) Street improvements adequate to accommodate traffic volume generated by the
proposed use and to provide safe, convenient access to the use shall either be in place or
shall be constructed in conjunction with the proposed use.
(3) Design of the proposed use is organized to minimize impact on and from adjacent
uses of land through installation of screen fences or landscape materials on the periphery
of the lot and by location of intensively utilized areas, access points, lighting and signs in
such a manner as to protect established neighborhood character.
9. Depending on the type of Conditional Use Permit requested, you may need to respond to
additional conditional use review standards in the Garfield County Zoning Resolution Section
5.03. Refer to the Section 5.03 of the Zoning Resolution which can be located on the Garfield
County web site at http://www.qarfield-county.com/building and planning/index.him or call this
office.
10. A $400.00 Base Fee: Applicant shall sign the "Agreement for Payment" form and provide the
fee with the application.
11. Submit 2 copies of this completed application form and all the required submittal materials to
the Building and Planning Department. Staff will request additional copies once the conditional
use permit application has been deemed technically complete.
II. PROCEDURAL REQUIREMENTS
(The following steps outline how the Conditional Use Permit application review process works in
Garfield County.)
1. Submit this completed application form (pages 1-4), base fee, and all submittal
requirements to the Garfield County Planning Department. It will be received and given to
a Staff Planner who will review the application for technical completeness.
2. Once the application is deemed technically complete, the Staff Planner will send you a
letter indicating the application is complete. In addition, Staff will also send you a "Public
Notice Form(s)" indicating the time and date of your hearing before the Board of County
Commissioners. Prior to the public hearing, Staff will provide you with a Staff Memorandum
regarding your requested Conditional Use Permit. (If Staff determines your application to
be deficient, a letter will be sent to you indicating that additional information is needed to
deem your application complete.)
3. It is solely the Applicant's responsibility to ensure proper noticing occurs regarding the
requested Conditional Use Permit for the public hearing. If proper notice has not occurred,
the public hearing will not occur. Notice requirements are as follows:
a. Notice by publication, including the name of the applicant, description of the subject
lot, a desc~iption of the proposed Conditional Use and nature of the hearing, and
the date, time and place for the hearing shall be given once in a newspaper of
general circulation in that portion of the County in which the subject property is
located at least thirty (30) but not more than sixty (60) days prior to the date of
such hearing, and proof of publication shall be presented at hearing by the
applicant.
b. Notice by mail, containing information as described under paragraph (1) above,
shall be mailed to all owners of record as shown in the County Assessor's Office of
lots within two hundred feet (200') of the subject lot and to all owners of mineral
interest in the subject property at least thirty (30) but not more than sixty (60) days
prior to such hearing time by certified return receipt mail, and receipts shall be
presented at the hearing by the applicant.
c. The site shall be posted such that the notice is clearly and conspicuously visible
from a public right-of-way, with notice signs provided by the Planning Department.
The posting must take place at least thirty {30) but not more than sixty (60) days
prior to the hearing date and is the sole responsibility of the applicant to post the
notice, and ensure that it remains posted until and during the date of the hearing.
4. The Applicant is required to appear before the Board of County Commissioners at the time
and date of the public hearing at which time the Board will consider the Conditional Use
request. In addition, the Applicant shall provide proof at the hearing that proper notice was
provided.
5. Once the Board makes a decision regarding the Conditional Use request, Staff will provide
the Applicant with a signed resolution memorializing the action taken by the Board.
Following the Board's approval, this office will issue the Conditional Use Permit to the
applicant. If the Board's approval includes specific conditions of approval to be met, this
office will not issue the Official Conditional Use Permit certificate until the applicant has
satisfied all conditions of approval. The Conditional Use Permit approval is not finalized
until this office has issued the Official Conditional Use Permit certificate signed by the
Chairman of the Board of County Commissioners.
I have read the statemen bove and have provided the required attached information
wh· 11-i reel and ac te to best of my knowledge.
I
( Date
Last Revised: 11/14/2002
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GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT
AGREEMENT FOR PAYMENT FORM
(Shall be submitted with application)
GARFIELD COUNTY (hereinafter COUNTY) and -------------------
(hereinafter APPLICANT) agree as follows:
1. APPLICANT has submitted to COUNTY an application for ___________ _
___________________ (hereinafter, THE PROJECT).
2. APPLICANT understands and agrees that Garfield County Resolution No. 98-09, as amended,
establishes a fee schedule for each type of subdivision or land use review applications, and the guidelines for the
administration of the fee structure.
3. APPLICANT and COUNTY agree that because of the size, nature or scope of the proposed
project, it is not possible at tills time to ascertain the full extent of the costs involved in processing the
application. APPLICANT agrees to make payment of the Base Fee, established for the PROJECT, and to
thereafter permit additional costs to be billed to APPLICANT. APPLICANT agrees to make additional
payments upon notification by the COUNTY when they are necessary as costs are incurred.
4. The Base Fee shall be in addition to and exclusive of any cost for publication or cost of consulting
service determined necessary by the Board of County Commissioners for the consideration of an application or
additional COUNTY staff time or expense not covered by the Base Fee. If actual recorded costs exceed the
initial Base Fee, APPLICANT shall pay additional billings to COUNTY to reimburse the COUNTY for the
processing of the PROJECT mentioned above. APPLICANT acknowledges that all billing shall be paid prior to
the final consideration by the COUNTY of any land use permit, zoning amendment, or subdivision plan.
APPLICANT
Signature· 'J
Date: /,}_ /,;( f/D r
r I
Dl/lJ 15-F 6RC £. lT8
Print Name
Mailing Address:---------
Page4
STATE OF COLORADO
OFFICE OF THE STATE ENb11'4EER
11• ~ llldo-. 1313 ~ 8'., o.-. ~ eoao>
CJ03)~1
PRIOR TO COMPLETING FORM, SEE INSTRUCTIONS ON REVERSE SIOE
1.· APPLICATION FOR WELL LOCATION AMENDMENT
WELL PERMIT NUMBER
2. weU. OWfl!E.B
NAME(S) . David Force
181!375
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DEC 2 9 20 ~~~ ' 01/" r.:•,, ::s
'' IC' • .,_ "L I c I ~ OWNER'S WEU. DESIGNATION ............. 71 ........ .! .. :-:' ... , ...... f., ........... , , I
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3. ACTUAL WELL LOCATION ; COUNTY ..... ~.il .. !' .. t.J .. ~).~ .................. .
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4. n... locallon of th• 8*lng well needs ~o be amended fol' the followfog reasoo(a): ~ eppropc\ale dOcumerUtlon aa nec::e&aaiy)
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s. I (We), the above ~•d owner{s) own the well descrlbed herein. I (we) f\8Ve read !he statements made he<eln.
know the~ thereof, and Slew that they are true to my (OUI) knOwtedge. (PUfSUant to Secllon 24-4-104 (13)(8) C.A.S.,
the making of false &talemems henlln constitutes pefjury In the eecond cSeQree and Is punishable as a class 1 mlldfmeanor.)
Name\Tltfe (Please type or P'fnt)
David Force
FOR OFFICE USE ONLY
ACCEPl'EI> PURSUANT TO POLICY MEMORANDUM »-t FOR A CBANGR IN WELL LOCt\TION ONLY.
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Court Case No................... . ... ....... Div . ...£ CO. .. :1...3. wo .. J..$?.. Basin MO
Fonn approved OMB No 2120-0036
U.S. Department of Transportation NOTICE OF LANDING AREA PROPOSAL Federal Aviation Administration
Name of Proponent, Individual , or Organization Address of Proponent, Individual , or Organization
(No., Street, City, State, Zip Code)
0Check if the property owner's name and address are different than above,
and list property owner's name and address on the reverse.
0 Establishment or Activation y Deactivation or abandonment } 0Airport D Ultraflight Flightpark D Vertiport
0 Alteration D Change of Status OF 0 Heliport D Seaplane Base D Other (Specify)
A. Location of Landlnn Area
1. Associated City/State 2. County/State (Physical Location of Airport) 3. Distance and Direction From
Associated City or Town
4. Name of Landing Area 5. Latitude ) 6. Longitude I 7. Elevation Miles Direction
•I · 1 " ·1 · 1 "
B. Purnose
Type Use If Change of Status or Alteration, Describe Change D Construction Dates
D Public Establishment or To Begin/Began Est. Completion
0 Private change to traffic
0 Private Use of Public pattern (Describe
Land/Waters on reverse)
Ref. AS above D. Landlnn Area Data Existinn fif anv\ Pronosed
Direction Distance 1. Airoort Seaolane Base or Fliohtoark Rwy#1 Rwy#2 Rwy#3 Rwy Rwy Rwy
C. Other Landing Areas From From Magnetic Bearing of Runway (s) or
Landing Landing Sea lane Area Area
Length of Runway (s) or Sealane (s)
in Feet
Width of Runway (s) or Sealane (s)
in Feet
Type of Runway Surface
(Concrete, Asphalt, Turf, Etc.)
2. Heliport
Dimensions of Final Approach and
Take off Area (FATO) in Feet
Dimensions of Touchdown and
Lift·Off Area (TLOF) in Feet
Magnetic Direction of Ingress/Egress
E. Obstructions Direction Distance Routes
Height From From Type of Surface -· Type Landing. Landing Landing (Turf, concrete, rooftop, etc.)
"' Area Area
3. All l Description of Lighting (If any) I Direction of Prevailing Wind
Landing
Areas
F. Operational Data
1. Estimated or Actual Number Based Aircraft
Airport, Present Anticipated Heliport Present Anticipated
Flightpark, (If est. indicate 5 Years (If est. indicate 5 Years
Seaplane base by letter "E? Hence by letter "E'? Hence
Multi-engine Under 3500 lbs. MGW
Single-engine Over 3500 lbs. MGW
Glider
G. Other Considerations Direction Distance 2. Average Number Monthly Landings
From From Present Anticipated Present Anticipated
Identification Landing Landing (If est. indicate 5 Years (If est. indicate 5 Years
Area Area by letter "E") Hence by letter "En) Hence
Jet Helicopter
Turboprop Ultralight
Prop Glider
3. Are IFR Procedures For The Airport Anticipated
0No 0Yes Within Years Type Navaid:
H. Application for Airport Licensing
0 Has Been Made LJ Not Required LJ County
OWiU Be Made Dstate D Municipal Authority
I. CERTIFICATION: I hereby certify that all of the above statements made by me are true and complete to the best of my knowledge.
Name, title (and address if different than above) of person filing Signature (in ink)
this notice -type or print
Date of Signature I Telephone No. (Precede with area code)
FAA Form 7480·1 (1-93) Supersedes Previous Ed1t1on Central Region Electronic Rev1s1on per ACE-625 (March, 2000)
Paperwork Reduction Act Matement: The information collected on this form is necessary because it is
the description of the physical and operational characteristics of the airport that will be on file with the
FAA. The information on all airports will be maintained in FAA computers for record keeping purposes
and used in airspace studies. Some of the information on public use airports is safety-critical and will be
published in flight information handbooks and charts for pilot use. The burden associated with completing
this form is estimated to be 30 minutes. Providing this information is mandatory ifthe proponent wishes
to have the airport on file with the FAA and entered into the National Airspace System No assurances of
confidentiality are given. An agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently valid OMB control number. The OMB
control number associated with this collection is 2120-0036.
INSTRUCTIONS
NOTICE OF LANDING AREA
PROPOSAL
As Used Herein, The Term "Airport" Means
Any Landing or Takeoff Area such as Airport, Heliport, Helistop, Vertiport, Gliderport, Seaplane Base,
Ultralight Flightpark, or Balloouport
Federal Aviation Regulations Part 157 requires all persons to notify the FAA at least 90 days before any construction,
alteration, activation, deactivation, or change to the status or use ofa civil or joint-use (civil/military) airport. Notice
is not required for the establishment of a temporary airport at which operations will be conducted under visual flight
rules (VFR) and will be used for less than 30 days with no more than 10 operations per day. Notice also is not
required for the intermittent use of a site that is not an established airport, which is used for less than one year and at
which flight operations will be conducted only under VFR. Intermittent use means the use of the site for no more
than 3 days in any one week and for no more than 10 operations per day.
Required notice shall be submitted on this form from each person who intends to do any of the following:
I. Construct or otheiwise establish a new airport or activate an airport.
2. Construct, realign, alter, or activate any runway, or other aircraft landing or takeoff area of an airport.
3. Construct realign, alter, or activate a taxiway associated with a landing or takeoff area on a public-use airport.
4. Deactivate, discontinue using, or abandon an airport or any landing or takeoff area of an airport for a period of one
year or more.
5. Deactivate, abandon, or discontinue using a taxiway associated with a landing or takeoff area on a public-use
airport.
6. Change the status of an airport from private use (use by the owner or use by the owner and other persons authorized
by the owner) to an airport open to the public or from public-use to another status.
7. Change status from !FR to VFR or VFR to !FR.
8. Establish or change any traffic pattern or traffic pattern altitude or direction.
The notice required shall be made by submitting this form to the nearest Federal Aviation Administration Regional
Office or Airports District Office. However, in an emergency involving essential public service or when the delay
arising from the 90-day advance notice requirement would result in an unreasonable hardship, you may provide
notice to the appropriate FAA Airports District/Field Office by telephone in lieu of submitting this form. The FAA
may require the subsequent submission of this form when necessary for safety or other reasons.
Section 901 of the Federal Aviation Act of 1958, as amended, provides that any person who violates a rule, regulation or order
issued under Title III of this Act shall be subject to a civil penalty not to exceed $ 1,000 for each violation.
GENERAL INSTRUCTIONS
1. For any project falling in categories 1, or 2 above, complete all appropriate sections.
2. For any project falling in categories 3, 4, or 5 above, complete sections A, B, D (if appropriate), and I.
3. For status change (categories 6 or 7 above), from private use to public use or from VFR to !FR, complete sections
A, B, E, G, and I. For all other changes, complete sections A, B, and I.
4. For traffic pattern establishment or change (category 8) complete all appropriate sections. Traffic pattern
description should be entered on the reverse side of FAA Form 7480-1.
5. Express all bearings as magnetic and mileages as nautical.
6. Please Print or Type All Items.
Section A -Identify Reference Datum of Coordinates (NAO 83 or NAO 27)
Section B -If the airport is to be used by the owner only, or by the owner and persons authorized by the owner, check
"private". If the landing and takeoff area of the airport is publicly owned and the operator is a non-government entity,
then check "private use of public lands". If the airport is to be available for use by the general public without a
requirement for prior approval of the owner or operator, then check "public". If necessary, use the reverse side of the
form or a separate sheet of paper to describe changes or alterations.
Section C -Airport or seaplane base: List VFR airports and heliportsw within 5NM, and IFR airports within 20NM.
Heliports: List VFR airports and heliports within 3NM and !FR airports within 1 ONM.
Section D -Attach U.S. Geological Survey quadrangle map or equivalent. Plot locations of facility to the nearest
second, runway alignments, associated taxiways or sealane alignments. When appropriate, use city map for heliports.
Section E -List and plot on quadrangle map or equivalent any obstructions within: 3NM of a VFR airport or a
seaplane base; 5NM of an !FR airport; or 5,000 feet of a heliport.
Section F -Self-explanatory.
Section G -List schools, churches and residential communities within a 2NM radius for airports and within a 1 NM
radius for heliports. List all waste disposal sites within a 5NM radius.
Section H -Self-explanatory.
Notification to the FAA does not waive the requirements of any other government agency.
ADDRESSES OF THE REGIONAL OFFICES
Submit your completed form by mail to the regional Airports Division office. For airports in Iowa, Kansas, Nebraska,
and Missouri ONLY, that address is :
FAAACE-625
901 Locust
Kansas City, MO 64106
Addresses for other regions can be obtained at http://www.faa.gov/am/acc/address.htm
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ORDER -w:j= 93022185
EXHIBIT "A
PROPERTY DESCRIPTION
A pai.-ce~ of land sltuated in Government Lot 1 of Section 30 1
Town11hi 6 South, range 89 !-lest of the Sixth :Principal Keridian,
County f Garfield, State of Colorado, naid parc..>l being more
particuJarly described as follows=
Commenc~nq et the North Quarter Corner of said section 30, a
&tone i place, the True Point of Beginning;
thence • 02 degree& 04'1'3" w. a dietance of 1168.24 fP.et,
thence • 85 degrees 01·01· w. a distance of 1372.18 feet;
thence . 01 degE"eeo 56' 38" E a distance of 1068. 53 feet
to a po~nt on the NoE"therly line of eaid Section 30;
thence ~· 80 degt"ees 56'51" E. along said Northerly line
a distance of 1390.30 feet to the Ti:ue Point of Beginning.
COUNT:i ~IF GARFIELD
STATE O COLORADO
TOOETHE WITH a 30 foot road easement aa deaci:lbed in Deed
recorde Auguat 10, 1987 in Book 718 at Page 782 ae Reception
::E:::8i5:~TH, BUT WITHOUT WARRANTY, any and all water and water
rights, ditch and ditch rights, springs, seeps, and wells, if any,
histori ally used upon or in connection with that certain real property
describ d herein.
j
Rocqi1ion No
R<ecrded 1!
WARRANTY DEED
nus D£ED, MJc lhl• 4TH d•y or Jl\.NUARY
OATMAN L. ooiboN l\.ND BETT! L. GORDON
ortM u1d County If pJl.RK -isw:oor roLORADO
GLENWOOD SPJUNGS, CO 81601
• 1~94
'g<a!ltol, o.nd :~:.:: ~~.,1:::. :~:·:::' W. FORO<, JR.
orlhc aid County f GAP.FIELD and State or COLORADO .granteco:
c.:0c0c"~'c'o':...:'c4c·c0c0~.~-----J
Wl™ESS, lh&e o gr..nlor, for and !ncon1idor&11on ofthC sum of GOOD AND VALUABLE
CONSIDEAATIO~ AND TEN DOLlARS, lho '.""~ip! and •urfioionq of whioli is hotoby
acknowledged. has g '41t<:d, bargoincd, oold lnd conveyed, and by these pruents docs gr&nl, barg11n, ooll, convey and conlitm, un\o tho
8'"'"""· their he\ra "'d as1ign1 forever, ""t In l<nancy in common but in joint lenancy, all 1he real propeny. lo got her with improvements,
i(any, 1itu111. lying and bclng in tho said County of GARFIELD and St&te of Colorado doscribcd as follo-:
AS SET FORTH ON EXHIBIT "A" A'!'TACHED HERETO AND MADE A PART HEREOF.
TOGF.TIIER wi all ond oingulw the hcrcdiwncnU and oppuncoanccs lhcrelo belonging, or ln onywise •ppen.o.ining. and \he rcvenion
and rcvcuiono, rem ir>dcr and rcmalndeu, rents, issues and proflts lhe,..,.,f, and all th• ostotc, rlghl, title, intorc.<I, claim and demand whal·
oocvor of!lte gr"'1!0 either in tow or equity. of. in and lo lh< above bargained promioeJ, with the hore<lltomcn1• and appunen.,,ccs.
TO HAVE AND fro 1101.D the said p<cmiscs 1bove bargained and <lc"'ribcd, wi1h the oppurmw1ce., unto the g<lntCCS, I heir heir• ond
.. ,igns forever. An~ the g,..,,tor, for bimsel(. hi1 hein1. aod pcr>Onal roprc.scntotivct, dn°' covenant, gront, borgain. and ogtoc to ""d with
the grantcu, their t ro uid u.oign1, !hot a• th~ time of th• onsco.lln& and dc!ive<y or1hosc prescnl!, he i• well sei1.ed ofihe p<otni••:< above
conveyed, hu goo4, •urc, perfeci. ab<0lu~ and indefeasible C!lWe or inbcri~cc, in tow, in fee simple, and has good rlghl, full power and
lawful authority log ant, bwgaln, ooll and cnnvey the .. me in manner and form u aforc>aid, and th•t thc same arc free and cl°'' f<om all
former and o(hcr 8'· ts, l>&rgaln•, sales, Ii"'"• tv.cs, as ... 1m.,,,u., cncumbranco.s anl rutriclions ofwhotevor kind or noture ooover, 01cept
real propert taxee. for the year 1994, not yet due or payable, and those
items ae set forch on Exhibit 'B" att<tehed hereto and made a part h.ereof.
The gnmlor shall and will WARRANTY AND FOREVER DEFEND lht above--b0<8line<I p~mi~o in the quiot and p.,.eublc po•o=;ion
oflhe gnLDIC>U, thei hein and ... lgn•, apl1>1l all ond every pc min or poroono lawfully claiming the whole or any port thc,..,.,f. The •inRular
number shall include the plural, \he plu1al the 1\ngulat, and l.h~ uoe of any gendct •hall be qpljooblc to Ill genders.
;.Wl~W[E~)0,1.h:=antor~cxcw<e<lthisdcedoqthedudo:?-/ kL
OATMAN L. iRDON BETTY tfaON
~~~~~~~~~~
SWcor coLoRAOo
)•.
County or abFIELD )
The foregoing ioll. umont WU aeknowlcd&cd before mo this 4'H JANUARY ,19 94 •
by OATMAN L GORDON AND fl!TTY L. GORDON
Mycoltlfllilfione iru 052397
FOIWHO.
CWS:4'
o~
STATE OF COLORADO
OFFICE OF THE STATE ENGINEOER
111 o...w.i 8'dlJ.. 1313 ~ Sl. 0.-, Oabmlo 8020)
(303) IOW.S81
PAJOA TO COMPLETING FOAM, SEE INSTRUCTIONS ON REVERSE SIDE
t.-~,. f. · ,/ &( Cd~ fj. /<-""'".£I
114 .2 I B~ 3 ".2.. Qo /06 ,.
1. APPLICATION FOR WELL LOCATION AMENDMENT -=·
WELL PERMIT NUMBER 187375 RECErVF fr
FEB 0 g '95
RECl' -~;t t~D
2. WEU. OWNER
NAME($) ..... David Forcg DEC 2 g}~t J04
..:·;·
,~·I
Malling Address ........ ~} -~ ~ .. c .. °. .. ~.~--~X ... R.~ a __ d···· 1. 6_ o ..
City, St. Zip ....... c:; ~--~ .n.'.".o .~.~-... ~_p _r}.~Jl .. ~ .. ~ ...... C..<? ....... 8.J .~ .0 .. 1 .......................... .
G/\RFIEl r .~;; -;:;' ~
8UILD,NG I ~ .;r.~11\G
-;Ll ;;,;1
~~
.-~ ~· ...-,,. PhOOe L. 3.P} ) .. ~ ~ .. ~--~-~-~-~ .. 8. ......................................... . 1--~~~~~~~~~~~~~~~~~~~~~~-'-~~~~~~~~~~~--1 ~ ~ 3. ACTUAL WELL LOCATION : coumv ..... 9..<l .. ~ .. U .e. .. ~-~--............ . OWNER'S WELL DESIGNATION ................... u ......................... . :a
~~· <.)
··••····•·•···········•• ~ ::'.>
(ljp) i;.. ::::: (SW.)
... _N_~ .. 1/4ollf>e .~.t-/ ...... 1/4, Sec. 30 Twp ... ~ .. ~.'?..IJ l .11 ................. , Range .. ~.9 . W.. e..~ t: .................... •····· -~-~.!:! .... P .M .
{Nol1h 01 Soulh) (e-or W..c)
Distances llom Section Lines
. . ... 9 .:1. o.. .. . Ft. from .. . N o . .r t b ... Section Une, 3 . .8 7 4 ... Ft. trom . East... ..... Section Line.
(£.at DI Well) (tb1tl Of South)
Lot . "······· .. . .......................... . Block Filing (Unit)
4. The IOCallon of the existing well needs to be amended fOf the folJaw!ng teason(s): (Anacn appropflale docume~allon as n~J
..................... 1.'..h.~ ... ~.r .. ~ .. 9..~ .. 11 .. ~..1 ...... V..~.~--~·-···1?..~ . .r: ~ i .. ~ ..... ~J .cJ ..... Tl .. t?.~ ... P.!.~ P.~.!= J Y ... i; .e. f..l .~.c .t .... ~.~-~ ..... ~.<:: c; .. ~ r .i' .. t:.~ ......... .
. ..... v~_ 11 ) gc;41 t .1 t?.!} ..... ~ .. U .. h..~.!'.l ... -~ ~ e .. .2..9. ()_. J .9 .q.~. -~~g -~_J ..... r.~qu ~ r~ "!I ~~--~ ........ Toe { e .f of.~.1 ............... .
.. ... .. ... d. is _t a.ll.£~.s } r <?.ltl .... t. ~-~·-· ~ e>. ~.'::.h .. ~ .. ~..d. ... ~.<! .. ~.~----~-~S ~ t9.P ... L. l n .1?.~ .... w~.r ~ ... P.~Q.P.~.L~Y... -~~~~JI.~--~~-
..... <l .. IJ.~L .. l?Y .. t ~ t~ ... am ~ 1.u;l .111~ ~.t ... ~ 9. ~-~q "1 r. i! .t;.~ l .Y .... "f! sc:; r.1 ~~ .. th .~ lci.c a. t<. J. on. .. o..f.. J h i .s .. \l.e.l. l ..
5. I (we), the above listed owner(s) own the well deSCc1bed herein I (we) hllve read the statements made herein,
know the oontenta !hereof, and state tl'l8l lhey are 1rue to my (our) knowtedge. (Pursuant to Section 24-4-104 (13J(aJ C .RS.,
the maklllg of t.ise statem&nl.9 herein oonstlUAes perJury In the second degtee and Is puolshable as a d&M 1 misdemeanor.)
Name\Tltle (Please type or prtnt)
David For c e
FOR OFFICE USE ONLY
ACCEPTEI> PURSUANT TO POLICY MEMORANDUM 93-1 FOR A CBANGE IN ~LL WCATION ONLV.
fD 3 ·llf-"->'
/Id ... ~ ... ~ ............... .
SW. Engl.-1 0-te
Cov11 Case No.................... ........ DN . . .. £ Co. ..l.3. wo .-3..!?.. Basin MD