Site Plan Review - Boulder County Land Use Department Page 7
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24Boulder County Land Use Department
Shaded Areas for Staff Only
Courthouse Annex Building
Intake Stamp
2045 13th Street • PO Box 471 • Boulder, Colorado 80302
Phone: 303-441-3930 • Fax: 303-441-4856
Email:
Web:
Office Hours: Mon., Wed., Thurs., Fri. 8 a.m. to 4:30 p.m.
Tuesday 10 a.m. to 4:30 p.m.
Application Form
Project Number
Project Name
Application Deadline:
Application Deadline:
R
Limited Impact Special Use
First Wednesday of the Month
Second Wednesday of the Month
R
Limited Impact Special Use Waiver
R
R
R
Variance
Sketch Plan
Rezoning
R
Modification of Special Use
R
R
R
Appeal
Preliminary Plan
Road/Easement Vacation
R
Site Plan Review
R
R
Final Plat
Location and Extent
R
Site Plan Review Waiver
R
R
Resubdivision (Replat)
Road Name Change
R
Subdivision Exemption
R
Special Use/SSDP
R
Exemption Plat
R
1041 State Interest Review
R
Other:
Location(s)/Street Address(es)
Subdivision Name
Lot(s)
Block(s)
Section(s)
Township(s)
Range(s)
Area in Acres
Existing Zoning
Existing Use of Property
Number of Proposed Lots
Proposed Water Supply
Proposed Sewage Disposal Method
Applicants:
Applicant/Property Owner
Email Address
Mailing Address
City
State
Zip Code
Phone
Fax
Applicant/Property Owner/Agent/Consultant
Email Address
Mailing Address
City
State
Zip Code
Phone
Fax
Agent/Consultant
Email Address
Mailing Address
City
State
Zip Code
Phone
Fax
Certification
(Please refer to the Regulations and Application Submittal Package for complete application requirements.)
I certify that I am signing this Application Form as an owner of record of the property included in the Application. I certify that the information and
exhibits I have submitted are true and correct to the best of my knowledge. I understand that all materials required by Boulder County must be
submitted prior to having this matter processed. I understand that public hearings or meetings may be required. I understand that I must sign an
Agreement of Payment for Application processing fees, and that additional fees or materials may be required as a result of considerations which
may arise in the processing of this docket. I understand that the road, school, and park dedications may be required as a condition of approval.
I understand that I am consenting to allow the County Staff involved in this application or their designees to enter onto and inspect the subject
property at any reasonable time, without obtaining any prior consent.
All landowners are required to sign application. If additional space is needed, attach additional sheet signed and dated.
Signature of Property Owner
Printed Name
Date
Signature of Property Owner
Printed Name
Date
The Land Use Director may waive the landowner signature requirement for good cause, under the applicable provisions of the Land Use Code.
Form: P/01 • Rev. 04.28.16 • g:/publications/planning/P01PlanningApplicationForm.pdf
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