Application To Amend Current Use By Special Review - Washington County State Of Colorado
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1APPLICATION TO AMEND CURRENT USE BY SPECIAL REVIEW
150 ASH AVE AKRON, COLORADO 80720
(970) 345-2701 Fax (970) 345-2702
$500.00
Permit Number
UAA________
WASHINGTON COUNTY
STATE OF COLORADO
Date of Application ______________________________ Original Case Number SP___________
(Office use only)
Name of applicant
________________________________________________________________
(email address)
Address _______________________________________________________________________
City,
St,
Zip
Telephone Number ____________________________ Fax_______________________________
Property Location:
Township____________Range_____________Section____________1/4Section___________
Nearest intersection and distance from
________________________________________________
Property Owner_____________
______________________________________________________
*SEE BELOW
Address________________________________________________________________________
City,
St,
Zip
Telephone Number ______________________________ Fax _________________________________
Purpose of Original Use by Special Review Request_____________________________________
Reason for Amendment Request ____________________________________________________
(If approved, amendment will be recorded by clerk and recorder)
I hereby certify that to the best of my knowledge the above information is true and correct.
Signature _______________________________________ Date ____________________
Applicant
Signature _______________________________________ Date ____________________
Property owner
Approved by:_____________________________________ Date ____________________
Commissioner Chairman
Special Use zoning designations are attached to the land or property for which they are granted.
Any amendments to equipment, buildings, or for the purpose the special use was originally sought
will be recorded with the Washington County Clerk and Recorder.
Please attach a one page letter on letterhead with the reason for your request for the amendment in
use for this property. Return this form with your letter and the above fee to the County
Commissioners at the above address.
*If ownership is other than fee simple in sole or joint tenancy such as a trust, partnership, tenants in
common, etc. please attach evidence of authority to pursue this application.
Make check payable to: Washington County
Rev 09/12
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