HomeMy WebLinkAboutPre-Application Conference SummaryGarfield County
CommunÍty Development Department
108Itb Sfreet, Suite 401
Glenwood Springs, CO 81601
(e70)94s-82t2
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PRE-APPLICATION
CONFERENCE SUMMARY
TAX PARCEL NUMBER:2181-063-00-135 PRE-APP DATEr 10120116
PROJECT: Hallett Wedding Facility
CURRENT OWNER: Fred Chaney
FUTURE OWNER OPERATOR AND APPLICANT: Richard Hallett
REPRESENTATIVES: Tim Thulson, Balcomb and Green
Mike Deer, Realtor ' ¡'¡¡
COMPREHENSIVE PLAN: Hesídential Medium High (2 < 6 Ac/DU)
PFACÏCAL LOCATION: 345 County Road 262, New Castle, CO 81647
TYPE OF APPLICATION: Administrative Beview for a Community Meeting Facility
ZONING: Bural
r. GENERAL PROJECT DESGRTPTT9N
The Applicant is proposing to operate a comrnunity meeting facilig for evenls to include,
weddings, corporate events, and similar gatherings. The facility would utilize existing
buildings on the site including a large two story bam (approximately 5,000 sq.ft.) and two
res¡dences. The barn would include spaces for wedding ceremonies, receptions, and
dancing. The residences could be utilized as guest houses for event part¡c¡panls. ln
general no cooking or indoor kitchen facilities are proposed as pad of the event facilig as
the events would be catered. However, an oulside BBQ area may be developed.
The site is approxirnatefy 20 acres in size and served by existing wells (2) and on site
waste water treatment facilities (OWTS). All other utilities are existing to the site. The site
is accessed off of County Road 262by a private driveway, Adequate on-site parking would
be required. The facilily would average around 100 attendees per evenl with an estimate
4v
of parking for 50 vehicles. The Applicant anticipates installing an elevator in the barn to
serve the second floor. At this time the Applicant did not anticipate building any new
slructures.
Key topics dÍscussed with the Applicant included:
¡ Verification that the existing wells can be used forthe commercíal use.. Documenlation that OWTS are adequate and in good cond¡t¡on along with the potential
use of portable facilities.o Structural enginearing revlew of the exisling barn and confirmation that it meels code
requirements andlor potential for remodeling and structural upgrading. Andy Schwaller,
Chief Building Official participated in lhe pre-applicalion meeting.. Provision of adeguate parking and potential need for upgraded County Road Access
Permit.. tnclusion of guest house/lodging associated with the use would likely require a
concurrenl review of a land use change permit for a lodging facility.
Given the developed nature of the site and the lack of any new structures waivers from
some submittal requirements (such as topography for lhe entire site) were discussed.
General information on lhe site including any special fealures, water bodies, steep slopes,
or natural/geologic hazards would need to be addressed by the submittals.
lt. SuMMARY OF REG.ULATORY PHOV¡S|9NS REQUTRED TO ADDRESS
Garfield Coung Comprehensive Plan 2030 as arnended
Garfield County Land Use and Developrnent Code as amendedo Article lll, Zoníng. RuralZone District - LolBuilding Hequirements (Table 3-201) and Use
Table fl'able 3403)o Article lV, Application and Review Procadures. Administrative Review Process (Section 4-103). Common Review ProcedurEs (Section 4-101)
' Table 4-1O2 Common Review Procedures and Required Notice. Application Materials (Table 4-201and Section 4-2031. Sections 4-118 and 4-202, Submittal Waivers and Waivers from
Standardso Article Vll, Standards - Division I General Standards, Division 2 General
Resource Proteclion Standards, Division 3 Site Planning as
applicable
III. ADMINISTRATIVEREVIEWPROCESS
ln summary, the Application will follow the Administrative Review Process contained in
Sections 4-101, 4-103 and Table 4-1A2:
a
a
1. Pre-application Conference
2. Submittalof 3 hard copies of the Application along with 1 Digital PDF copy.
3. Review by statf forTechnically Complete Status
4. lf Technically Complete the Applicant will be notified, the request scheduled for a
decision by the Director. lf Not Technically Complete the Applicant will be advised of
ihe deficiencies and will have 60 days to address completeness topics.
5. Applicant completes public notice mailing by certified mailto adjacent properly owners
within 200 ft. and mineral rights owners on the property. The mailing is required to be
a minimum of 15 days priorto the DirectoCs Decision.
6. Staff prepares a report including public and refenal comments.
7. The Direclo/s Decision is documented by letter as of the noticed date.
8. 10 day call up permit where the Applicant and adjacent property owners can request
that the decision be reviewed by the Board of County Commissioners.
9. Director issues the Land Use Change Permit if no requests for a call-up are received
and once all conditions of approval have been met.
10.The Applicant has one year from the date of the decision to address the conditions of
approval. Extensions can be requested.
IV, SUMMARY OF SUBMITTAL REQUIREMENTS - KEY TOPICS
General Application Forms and attachments including agreemenl to pay form,
application fees, evidence of ownership such as a deed for the property, and
narative description of the proposal. ïhe general information also needs to ínclude
a list of proparty owners within 200 ft. and any mineral rights owners on the subject
property.. lf ownership is held in a trust, documents will
need to be provided establishing who the
trustees are and verifyíng their authority to sign
for and represent the trust.r Vicinity Map (including lhe area generally withln
3 miles of the site)r Site plan with information on proposed location
of the community meeting facili$, any other
existing structures, and significant features on
the property (i.e. easements, utilities, ditches
etc.). Grading & Drainage Plans - a submittal waiver
to defer grading and drainage may be requested
and should be supported by an assessmenl of
the site confirming that the existing drainage is
adequate and that no drainage problems exist.
Addition of significant areas of imperuious
surfacing (i.e. parking areas) would require
drainage plans.. Landscaping Plans as appropriate based on the
existing condition of the propefiy.
a
Application Submittal
3 Hard Copies
1 O¡gita¡ PoF Copy (on C0 o¡ USB ¡tick)
Both the paper and the digital copy
should be split into individual sections,
Please refer to the list included in your
pre-application conference summary for
the submiltal requírements th¿t are
appropriate for your application:
r General Applicatlon Materials. Vicinity Map. Site Plan. Gradlngand Oralnage Plan. l¡nd5€ôpe Plan. lmpacl Analysis. Traffíc Study. water Supply/ûfstributlon Plan- Wsslewatet Mana8e¡nent Plôn. Article 7 Stand¿rds
. lmpact Analysis - basic descriptive information should be provided. Submittal
waivers from detailed plans incfuding wildlife habitat may be requested. General
information on habllat may be available from the Colorado Parks and Wildlife.
Typical practices lo rninímize impacts on wildlife {i.e. use of bear proof trash
containers or storage of lrash within structures) are oflen proposed.. Development and lmprovements Agreements are typically not applicable (no vesting
issues and no public improvements).. Tratfic Study - General information on the County Fload tratfic is available from the
County Road and Bridge Department. lf waivers are requested from all or a portion
of the sludy requiremenls, it needs to be suppoñed by lechnical information. A new
County Hoad Access permit will be required and a copy of the permit or evidence
that an application has been filed should be provided.r Water supply plan and supporting documenlation. Documentation of legal waler
(commercial use of the wells allowed), adeguate well production and water quality
testing. The plan should include any plans for temporary water seruice.¡ Waste Water Plans and supporting documentation demonstraling adequacy of the
existing facilities and/or any proposals for supplemental podable toilet use.r lnformation to address applicable sections of Article 7, Division l, ll, and lll are
needed. Application formats lhat respond to each section are recommended. Key
topics include any hazards (generalmapping can be provided), comprehensive plan
(statements of compliance), utilities (references to existing or planned services), and
access (address any Road and Bridge concems).. Engineering information on the bam structure documenting compliance with code
requirements including snow load and fire protection (potential for fire sprinlçlers)¡ Waiver requests need to address applicable review criteria (Sections 4-202 & 4-118)
The Application submittal needs to include 3 hard copies of the entire Application and 1
Digital PDF Copy of the entire Application (on a CD or USB Stick). Both the paper and
digital copies should be split into individual sections. Please refer to lhis pre-applícation
summary for submittal requirements that are appropriate for your Applicalion.
Please note lhat if a lodging facility is proposed it would raquire an application for a Limited
lmpact Review Land Use Change Permit and would require a public headng before the
Board of County Commissioners. The lodging facili$ application can be under review
concurrently with the community meeting facility and additional pre-application
meetings/discussions with Statf would be appropriate to discuss the timing for that review.
Additional meetings with Staff can also be scheduled to address specific questions
regarding submittal waivers.
V, APPLICATION REVIEW
a. Review by: Statf for completeness recommendation and referral agencies for additíonal
technical review
b. Public Hearing:-X_ Director Decision with notioe (not a public hearing)
_ Planning Commission
_ Board of County Commissioners
_ Board of Adjustment
c. Anticipated ReferralAgencies may include but are not limited to:
Garfield County Road and Bridge
Garfield County Attomey
Fire Protection District
Garfield County Environmental Health Manager
Garfield County Vegelation Manager
Colorado Division of Water Resources
County Consulting Engineer
VI. APPUCATION REVIEW FEES
a. Planning Review Fees:$ J5&@_
b. Referral Agency Fees: $-na_ {may be billed separately}
c. Total Deposit: $150.00- (additionalhours are billed at $10.50_/hour)
vil. GENERALAPPLTCATTONPROCESSTNq
Planner reviews lhe case for completeness and sends to referral agencies for commenls.
Planner will contact lhe Applicant and set up a site visit. Planning Staff reviews application
to determine if it meels standards of review. Planner makes a recommendation of approval,
approval with conditions, or denial to the appropriate hearing body which in the case of
Adrninistrative review is the Director of lhe Community Development Department.
vill. tltscLAlMER
The foregoing summary is advisory in nature only and is not binding on the County. The
summary is based on current zoning, which is subject to change in lhe future, and upon
factual representatlons that may or may nol be accurate. This summary does nol creale a
legal or vested right. This summary is valid for 6 months after which time an update needs
to be requested.
lX. ApplicationSubmittal-Publiclnformation
The Applicant is advised that the Application submittal once accepted by the County
becomes public information and will be available {including electronically} for review by the
public. Proprietary information can be redacted from documents priorto submittal.
X. PHFAPPLIÇATION SUMMARY PREPARED BY¡
Glenn Hartmann
Senior Planner
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Date
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"SONÞlTlüül$r|, Ål{ irlf Ëllrt¡sñ nrutt rürilptl rrr¡th rlt rü*i¡arn+lt_r d fhi tpilnty lndrridur! Sørr¡r Þtpg¡rl Fr$¡lrt¡rnt" $$Ft¿r, Þjr¡ûürt tg au!,rhottty gt¡nrrd tn tû.4{,,t. Cfiü tgü5, }i:rrndrd 6ı.&,î¡.Cn¡ ltú¡_ - - --'
?. Thi¡ pcrrnlt k vrlid only ftt ccnnaçtion Ns r¡ruÊrrrrËr,,+¡lg'rhrni rrrrh oornoJiyl wl¡h cor¡nry roninE lrd b*rrrlin¡ruquir.rî*¡!{!_tonnçction lÊ tt urß $lth rnf' drr*åling ût rrtuelurtl not *pÊ,roïfft ¡v itr¡ Eu;t¿¡¡rn rod xonlng o.llior lhrn ¡utountticrlly b+ ¡ rlob.tior +l r r*quJr¿rnrnt Êl thÊ Frrrnlt ¡¡d c¡u¡r lsr ä$th r.gi i*ifo" r"U i""ocrt¡on ,s, tht p**$it,3, Soctian lll. t,?4 ruquhtr rrìl prr¡e{r r,rÍ,ç 6s,¡¡¡¡¡ç¡¡, ¡llir¡. orìn¡frllr'inln¿¡ridurl *wrryrditFö}rlrlrróm inr Êr*nnürïrüich an.¡olvr¡ r krror{rí*g md {nrÌrr¡ll tt.¡åtiûñ trom ttr€ tûrrn or ip.*¡l¡iii""i-çÞnr¡irid ¡n *lipoliür¡on åt parmir cûûîmjr¡ r tlr¡¡ 1..Prtty O{trnra lSSOü,0fi llru - 6 rnonrh¡ in i¡;fi ør holt¡I.
Erritdin3 tlfici¡! - F;rrnh !îhita Cog:y Åppllcxrr "- Ëra:¡ Ç¡4ry Drpr, _ p¡nk ç$Fï
L-r tt'l.jnr *r ., I tutâ ' ltn ,
vl r rvi vrùF¿ge ïrrvo
II{DIVIfruft Hil{E SENAGE THËATHE¡{T STSIE¡Ts AFPI-TCÅTIOI{
4
t'lall Âddress; f} ,Ê 4t ,â/^"2. p tl ty:z r p, B-JS.{Jrnom : #d JF{
respect tc suroundlng ðrtas"
l+ i+¡tsr uulll, soll purcola-
l'lear l{hat
C1 ty or Town ,Ll*if*¡ügL
Fees P¡ld t-lÇ-æ.ad-c
0Èrç b-ta:6?J
rlllo-El¡J¡m n
Attlch seprrlte shcets 0r rÊpûrt rho*tng entlrt arer nlth
topogrËphy of rrea, hrblt¡bìe bulldlngs, locatlon of potåb
tlôn-teit holes, soll proflle¡ ln test ho'l*s (cee Page 3).
{lxçr;
É
'l " l.oc¡tlon of Facf I I ly: CountY G,{RF¡ EI.O
Locrtlon Addrer
legail ûescrlptl tt
t. fto" sf Bedrooms 3 - Septlc fr*t ñ¡clty -Lil{L-.Àaratlon Unlt taprctty .- tU,A -.'-J
S" $ource of Dcnp¡tlc l.Içter: PuHic (nam): .--__
Prlvatê: lfaltr { Oepth ttfier Depth to lst grourtd Hater tlbÏe __.4
4, ls frc{'llty rithln boundarle¡ af ¿ c{ty/totrn or s¡nltåtlon dl¡trfc[?
5, 0lctancs t0 nÈåFåst sener *ystwt:.flP 'r.t :
Hrve ¡ou rttenptnd tÕ årrångn n conmctlon rllth the :ystem?
Xf rêJÉËtÊd, ufirt lru$ thÉ r*¿con?
If R.P.t. tested, åtåtÊ r¡te rf abrorptlon in tsÉt holes thürn on tht lncatlon màp, in
mlnutec per lneh sf rlrop ln r¡tar level ¡fter hslss have been çs¡ked for 2,1 houns:
7 l{ame, addre*" and telephone of E"P.E. ulro made soll ¡bsarption tests:
8. Harne. addre:*, tnd telaphone of R,P,E. reÊFtrnstbtre fsr deslgn of the syÈtêr*:
I f¡1prs$6 porrrrlsslon 1s hereby gr*nt*d for tfte lnspentlon of the übtrê proFrrtf by äntr
reinber oÍ the Êarfleld tounty 8ulìdlng I Srnitrtlon flspñrtffint and/or such persons ts
they m¡y deslgnrte. Any wfthdruwrl oi thls perrrtlssfon shall be ln wrfting and recelpt
ack-nolrlãdqed by the County $ulldlng t $anlt¿tlon Department.
'tû.I hrve been g{vÉfi ür1 opportunlty
t1Èni ûf S¡rfiel¿ Êounty ¡id n he
requ'l remsnls ,fncTuded therein.
to rerd the trndlyldutl $er¡
rtby agree ts comply vdth r
gÊ
II Dlsposal Systeun Regula-
terfls, condltions ¡nd
0ats
{Tt Br cHTr¡Rflg0 T0 8LnG" ß StrllI" ÐËPT.¡
fðn
ïr
üåRflÊLD coUlfTY EülLût!{,{¡ lt}¡tr SttllrAlltH üEp fiTt Eilf
lÛtt ¡¡l¡r *$lrr¡.
Shnrood 5¡rln¡r" Cûlot dÈ tldûl
ttl*nr {Sct} S4¡.t¡*l
pÉafitT FEE mLT - FrRf RITE filü¡|il{ {$EE PEü|IT l9l7}
INOIVIDUAL $EI¡UAGE DlsFosAL FEnMIT tlg ! t ft
Thhdorr ml ætlrl¡httr
¡ hu¡ld¡ng er u¡r Þrrl¡it,
{t3úE fß* ftnrd. lfar trctls8y¡trm Lserl"¡on
Ll(rnrld lñrlal[or
ll¡f
ı¡rr
' Ccñditiona¡ ConrtrsçlrcE rFFrwr¡ ir lrr¡råç grr4tld lgl r 1 -{t{1{!
---XtlL Soprir T¡fih or
-
AÉÉiied ttalltñ.rrl uñit.
{tllot1
¡lbt+rFl¡ofl ¡rcr fcr di¡Frr¡¡! r¡lrl çomPul*d ¡r folloryr¡ -+ -\t
Fñc{rft orrnr¡nch n | 3 ;r"Jffi"ffi,'#,1|r1i44-,.tt, ot rbûorlt¡sã ¡rü Hdrôôfr1-
î'hr¡¡loru rbl m. sl búttrûÊ.ìÌr I r 3$9lq'f!" rninirnum rtquhrñlint - r loñl ot ðl ¡b*Drptlon $rr.
wt ftrgût¡l têtlqlt { ,o'r <o'11
lâtú{tÊlÕ¡
,)
FI{î¡AL
.t3
TF SVSTEM:
wlf¡cr.
P¡o¡** m!¡!r¡ål¡ rnd ¡*tmbly
l{tr rytur¡i rhrll br d¡un¡d ts bt iF co¡nFlirncç ¡rilh th* $*rr4a Ûl*pofil Lr¡n ¡¡nfil lh{ ll$Ébhd ryrlwn
añc tnY 9ü¡.
nÊ*Srpt¡* llnh lct¡$ lqr ,ô¡rËt!rod tnd ç.lrrnilrBrvirhiñ t t" et ryd{tú}d tu¡ltpl cr
tpprûr¡rf prlil rêçÞr{r'
pcrrr ¡bolt ¡round* l¡<*", ,lo L*L .,,,¿{ ,,,* { .r..', ,t*..
Tîr¡dr n¡lnr ol rrpt¡ç lrnt rr ¡a.ttd trl¡tûrtn! un¡1. t" ÐlfÉ{'
Âd¡{u¡rr rb¡rrp!¡er¡ lçr di¡pça¡¡tl rrr¡, -2,ø ' Í" 4 t' >tJ Z,rr-l 4*{
{¡
c,f,.
.otl,
I .fì ¡.
,0,",f L.,f*,,:,
-'i,n, ,,n.' .
-,- "*--#Il{** ¡4rhq$rf* ço¡¡*¡¡lir*ræ rith lrr¡nit m{uir¡n*nt¡-
{}r.=ådrqu¡tr oçmtrfu¡ngf |riih Cçr¡n!T lnd Silt* lo¡uhtionilff,quirrrîÈrr!*.
- tth*¡'Ì*
"|t¡
E'årÉ ln¡oælor
A'f{ WITH NECEIPT flEËOBÞ$ AT COÌISTRUCTIûI'¡ SITE
.tüHDtTrtNS:
l" All rn¡t¡lhríu.r lt1út! çsttrpty with tll ¡tçfi¡irçrüintt öl tlrr Oounty lndivldr¡¡l $rwrç Ëiry+lrl Éç{slrti*ni" ltdoptrd Fürr¡rnt to ¡u'
tho¡ítT {r¡n¡¡d ¡n SË {{.,1, Gñ5 lÊ63. ¡marrdcd Ët'}lrt. GFS tFg!,
t. Thíf çrm¡t in yg¡ú on¡T lçs çonna{tlon tg ttruçturf,r ï{r¡l'r h¡lû k¡llf Êûntli?d with Cûr¡ñiy ¡oning ¡nd huitdtng trquirunr.ntl-
Ëonmction tû ûr n!ã r,vith rny dr.r,Ëlliû0 Êr ttrt¡Ëtr¡$* n,st ¡Fprorrd !v tùr ãuiidín¡ ¡nd lçnin¡ gll¡H thilt ruloFutierlly br r vioh-
licn ol ¡ r+quirarn+*r ol thr Ër¡nit rrrú €trr¡* fÊr bpü lr$l aclicn ¡fid rrrycttrion ol rh¡ Ë¡¡rrt.il,
.1. S¡clicrr llt. $.il rar¡u¡rËr |try p.rrçn r.ehs ççnrtrþçli, ¡lttil. ür anrtillr fn,ind*rllçrl¡Êrr$idalpo¡tl¡ï¡¡tm lnamr,lnNI llfi1Êfi ¡n-
tqlrçr t knorringmd rÛ¡rr¡¡l rr¡i¡l¡on trûm lhr i€tlnt êr tûÊqífiçål¡onf çs,4lr¡rrçd ¡n:hraFplifll¡ortolg¡rrnrtcûtnñiltrClS¡ ¡,
Ftt tr üllrnË {S50t OO linr - t üronrhc rn í¡il ar bo thl,
trt¡¡¡*Et I çr.p Ê{tf l¡ttrtrtffitr l¡lll CåÞll
lßg.LtLuuAL- -[.0!!Ë.JW eP$ I q¡il!!.I5ÅGE TIJOl¡
OHffEN
À0DnE55
ÅPFut*ÌiT
AIIDftESS
pt{üil8 ]^
pHCInE Ídltll t¿?:
t0t{TRAIT0ft
AOTRESS FHffiE
l$l[¡ltf-tg$: (l(l l{eil lnsta!1rt{on { } Alterütion { ) reprlr
Åttâch ËEpüràta EheÊtr ûr rÊpürt shorlng_entlrë örså rlüh respßËt,_to iurrÛiJnding
lidii, roþography ôf årer, h¡bit¡ble þuildfngr, locrtlsn of pottbls t{tter *êì1er
ro'll perchlitlon test hoìes, eoll proflles in tsst holes.
IÛCA-[Iülìl {tt PR0F05tf¡ tAilLITI:CountY
lle¡r..uhat t{ty or Tsr*n
Legrl ÐescrlPtlon
rÈ\,&"
Lot $f¡e JS
|IA5IES TT[år { }fl ûçel] ins
{ I üormerc{al or Instltutlonal
tJat an afforÈ n¡de to connect tû cilrllt¡rlty syst+ñ?
TLF E tF I r!!)J ìt I pu¡L,5 ErJffi F. 3 I 5P05{L-åTåI t }r.jruggågg.:
( l Tr¡nsleflt Use
{ } Hon-douestlc llästÊs
{ }Other-tescrlbe¡
qu_LLs_!!H.-88 -EEEM-ç-ffI :r i.HumbEr of Ferlons 8,,,
Hunber of Bndroons
{rf } G¡rbage grlnder { f} Automatlc r¡¡çher {lr} b¡Eh'u¡sher
Ê[UE[E-. Atrlt TYPE:gt 8- LJ : {"f,} re]t { } sprf ng { } stream or creelt
Ê1ve depth of all tçlls nithlrt 1t0 fcet of syst'em:
tf rupplled by cor¡lun{ty x¡ter, !{ve nante of, suppller:
Oepth ts ftrst ßrtund l{at*r T¡bl*:JË d ,li4t t
PercenI ground sloPe:
gJ srÅlïgL T0 . iltFnEsI tq!$utr U L ågSå!.-5ï $TËf'l r h¡t.'
üftsu¡iÞ Ë01{0lIlsltsr
Dapth tCI tsdroski #
/lJo
{,t/} SePtlc Tank
't )ttaultFrlvy
t I Pit Prl'¡y
{ I ctrern"lc¡l Tsilpt
ilw.,,[).IsFÛSAI= 11:
) A*rltlon fl¡nt
J tornpoçt{ng To{l*t
l Inclner¡tlsn To'llet
l V¡ulr
| ftcc¡cllng, potable use
! Recye'Hng' other use
{
{
{
(
{
{
t
{
l 0thÊr - Betcrfbe;
) Jtbsorptlon Treneh, Bsd ar Flt { ) tvrpotr¡nlBlrutlcn
) Underground Dirperret ( l San¿ Fllter
I Aboue tround 0l¡Ferstl { } t{rstery¡tcr Pond
l 0ttrer - Dercrlhè:
-
-.:-----'------_-.--'-
t¡
ïtLr .rJtLU_ErlL BE gI5{H¡qR6EÐ ÛULESJL_T_l!fÏ! }l!4J-Ë!S, ÛF. IHE SÏATE?ttrn
sTsTtFt 15 0tsl6ftEn F$s ,ßALL{üS rtft [u
r,Jlüt tltRfI
ns*r lRptl, stttü
n[¡tEË per lnchlf the syrlËr tr to bl de¡ignÈd hy r fuglsterËd Frofes¡lontl .[nglrtt; üf ãbsorptforr ln tr¡t ho'ltc si¡üm on thË lo{Ðt1ûrt øaF,.ln rl
of-úr.çp {n xli¡r]ersl ¡ftpr hole¡ hrvr bsan roattd fsr ?lt hnur¡:
srrL PrRcÛLl,Tl0H. TE$T Rts_UtIå:
l{lnutc¡ p*r lnch lr'¡ hrls lfo. I }linutä3 ** fler Inch {n hsl$ T{t" 3
Itinr¡ter pËr {nch ln ho}c tto. Í }l{nutet
-;FEr
lnfh ln holF l{û.
-l,h¡x, ¡ddness, and t*Tcphone uf RFt rtx rnde ltt'l eblCIrpfion teÊt5:
--i{¡lr, ¿ddre¡¡f åild te}ephnne of FPE retponrlbl* for detlgn nf tll* ãy9teill
A¡cllr¡nt rcknorvlrdge¡ thüt thr cpmplctrnp¡¡ of the tpfllcltton i¡ condltlonll
;ffi';ili i;;ffii-rd^ã¡iöiy iø ¡ttcitlonrl tmtr and rtportr ü3 rtltt.bt rtqulrrd
¡i-ilr--iocoi ñeilth ¿åfqrtment tp b* lrde ¡rd furnlshÊd by the rppllcant ol br
thr toctl hcrrlt¡ iep¡r.l*ni-fsr purFnrÊr sf thç tvnlu¡tiqn uf th* applicattronl ¡nd
iñ iiiuiric oi ttre'F€rlnlt lå lubJsit to ¡ue h ttmr ¡nd aandlt{ofi* as dt¡tntd
ñiirriiil'ið inçuiã co*liirnir *iltr rr¡1n¡ rnd.rrgu]¡tJsns ¡dspted und*r Ant{cls t0n
ïiii; f t, c.n"S" 'f gli-ü-t*enáeo" The r¡nderrlgøåd herebf cprt{f ie¡ thrt rÏl
st¿teqneni.r n¡üde, 1-nforrnrtJon tnd reportÉ st¡bftitted here*ith ar¡d requlred ta.be
+"n"itiø by tnå rppl icar¡t rrß âr ril¡ tre repre¡ented tc bs truç and ccrr*çt to
rhp hecr 0f *1r *nãiiiåıå inã toi{af rnd-irc }st{sntd 16 hÊ rrllcú ?n !llfg l5il--
dupaa-trnent rf h!êrltft l; evnluating the grne_f1".FurpüÈÊt lrrulng the petrlt ùFflleo
iãF-lo"nil".- t funitrer undercrånd thrt ËnI f¡lsification or mlsrÊprËEentrtton ma¡r
r*¡r¡lt in the uenill of the appllçatfon sÞ r*uorat-lon of nny pcrmft gr¡nted bl¡rd
;pd itiä ipetiiitisn ¡n* tn iktl Ëatlon fnr prrJur! ði prsvldtd hf l¡r'
[¡t s _åÅ_**_å¿*__ lÍlnsd
ruË!5! -.p{$}.|**!1iEI"uåI E. &1.P-YNIJR FRÛP EnrrTfi