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Home My WebLink About01 Application FormAPPLICATION FORM AND PAYMENT FORM O\OLSSON ASSOCIATES THIS PAGE LEFT BLANK FOR TWO-SIDED DUPLICATION. O\OLSSON ASSOCIATES Garfield County Community Development Department 108 8"' Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com LAND USE CHANGE PERMIT APPLICATION FORM TYPE OF APPLICATION ■ Administrative Review • Development in 100 -Year Floodplain • Limited Impact Review • Development in 100 -Year Floodplain Variance ■ Major Impact Review • Code Text Amendment • Amendments to an Approved LUCP • _ Rezoning • LIR • MIR • SUP • Zone District ■ PUD ■ PUD Amendment • Minor Temporary Housing Facility • Administrative Interpretation • Vacation of a County Road/Public ROW • _ Appeal of Administrative Interpretation • Location and Extent Review • Areas and Activities of State Interest • Comprehensive Plan Amendment • _ Accommodation Pursuant to Fair Housing Act • Pipeline Development • Variance • Time Extension (also check type of original application) INVOLVED PARTIES Owner/Applicant Name: Ursa Operating Company and Battlement Mesa Land Investments Parcel I Phone: (970 ) 284-3244 Mailing address: 792 Buckhorn Drive City: Rifle State: CO Zip Code: 81650 E-mail: cmascioli@ursaresources.com, jlind@ursaresources.com, and eric@schmela.com Representative (Authorization Required) Name: Tilda Evans Phone: ( 970 ) 263-6015 Mailing Address: 760 Horizon Drive, Suite 102 City: Grand Junction E-mail: tevans@olssonassociates.com State: CO Zip Code: 81506 PROJECT NAME AND LOCATION Project Name: Battlement Mesa PUD Phase II BMC L Assessor's Parcel Number: 2407 082 00 183 Physical/Street Address: Legal Description: PARCEL 1; Section: 8 Township: 7 Range: 95 A PARCEL OF LAND LOCATED IN UNPLATTED LANDS OF BATTLEMENT MESA PUD Zone District: PUD LDR Property Size (acres): 57.68 PROJECT DESCRIPTION Existing Use: Open space Proposed Use (From Use Table 3-403): Natural Gas Well Pad Description of Project: Natural as well pad with 31 natural gas wells and appurtenant pipelines which will be separate application. The pad site will be approximately 2.8 acres. There will be six 300 bbl tanks to store condensate and produced water. REQUEST FOR WAIVERS Submission Requirements ▪ The Applicant requesting a Waiver of Submission Requirements per Section 4-202. List: Section: 4-203.J Development Agreement Section: 4-203.K Improvements Agreement Section: Section: Waiver of Standards B The Applicant is requesting a Waiver of Standards per Section 4-118. List: Section: 7-107 Access and Roadways Standards Section: Section: Section: I have read the statements above and have provided the required attached information which is correct and accurate to the best of my knowledge. Signature of Prope Owner COUAD 4/23/ zCirI Date OFFICIAL USE ONLY File Number: Fee Paid: $ Garfield County PAYMENT AGREEMENT FORM GARFIELD COUNTY ("COUNTY") and Property Owner ("APPLICANT") Ursa Operating Company LLC agree as follows: 1. The Applicant has submitted to the County an application for the following Project: BMC L Pad 2. The Applicant understands and agrees that Garfield County Resolution No. 2014-60, as amended, establishes a fee schedule for each type application, and the guidelines for the administration of the fee structure. 3. The Applicant and the County agree that because of the size, nature or scope of the proposed project, it is not possible at this time to ascertain the full extent of the costs involved in processing the application. The Applicant agrees to make payment of the Base Fee, established for the Project, and to thereafter permit additional costs to be billed to the Applicant. The 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, the Applicant shall pay additional billings to the County to reimburse the County for the processing of the Project. The Applicant acknowledges that all billing shall be paid prior to the final consideration by the County of any Land Use Change or Division of Land. I hereby agree to pay all fees related to this application: Billing Contact Person:Jennifer Lind Billing Contact Address: 1050 17th Street, Suite 2400 Phone: (720 ) 508-8362 City: DenverState: CO Zip Code: 80265 Billing Contact Email: jlind@ursaresources.com Printed Name of Person Authorized to Sign: Jennifer Lind C___20A-x-c-0-, 3/21/2017 (Signature) (Date)