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Planning & Building Department SPECIAL USE REVIEW Application Form Planning & Building Department [PHONE REDACTED] * Fax: [PHONE REDACTED] 1290 S. Public Road, Lafayette, CO 80026 Email: [EMAIL REDACTED] Date Filed: Amount Paid: File Number: Fax: E-mail Date of First Pre-Application Conference Fee Paid Date of Second Pre-Application Conference Fee Paid Required information to be submitted with this form: 1. Ten (10) copies of an accurate site plan drawn at a scale of 1" equal to 100' or a division of 100' by an even number, which shall include: a. All buildings and other improvements b. Ingress, egress, parking, and loading areas c. Landscaping and tabulated date, fence, and screening size, shape, height, and location of all signs. d. Location of service and refuse collection areas e. Location and type of outdoor lighting f. Grading and drainage plan g. Location of all proposed utility connections h. Traffic report (if applicable) 2. Legal description of property 3. Submission shall include a JPEG image, an optimized PDF, and an 11” x 17” copy of each drawing. Three jump/flash drives containing an electronic version of all application materials required. 4. A complete landscaping and irrigation plan in compliance with Code Section 26-19.5, as amended. Landscape plans for both public and/or private projects, except for single-family and multi-family with 4 units or less require the stamp of a licensed landscape architect as required by C.R.S. Section 12-45-101. 5. A public hearing fee shall be included with all applications requiring a public hearing. This fee does not include the cost of publishing public notices or postage. 6. Mailing labels and funds for first class postage for all property owners within 750 feet of the outside boundaries of the property under review and a list and map of those owners. 7. Certification of Mineral Interest Notice completed. (See page 3 of this application.) 8. Copies of the neighborhood meeting sign-in sheets as well as comment cards received by the applicant at the neighborhood meeting shall be submitted per Section 26-16-3(b). Complete the following information (use separate sheet for 1. Location of proposed use: 2. Current zoning 3. Proposed use: 4. Describe how this application and the proposed special use comply with the City’s Municipal Code. 5. Describe the compatibility of the proposed use with the existing character of the surrounding area. 6. Describe the desirability and the need for the proposed use in the specific area of the community, and the community as a whole. 7. Describe any negative impacts, both environmentally and physically, that may result from the proposed use and how these impacts are proposed to be reduced. 8. Describe the compatibility of the proposed use and the site plan with the current Comprehensive Plan. 9. Will the general health, safety, and welfare of the City residents be affected by this request? 10. Listing of materials to be used in building construction and siding: (New buildings only) Pre-application conference(s) with the community development director or director’s representative is required prior to submitting an application. Fees associated with the pre-application conference must be paid at the time of the conference. The Community Development Director reviews special use reviews, or the Director may refer the application to the Planning Commission. The action of the Planning Staff may be appealed by the owner, neighboring property owners, or Planning Commission within 14 days of staff’s decision. The applicant or a duly authorized representative must be present at any and all public meetings to answer any questions raised by the Planning Commission or the general public. ---PAGE BREAK--- I hereby certify that I am the legal owner(s) or contract purchaser of the above-described property; that I desire to apply for a Special Use Review and that the information contained herein is true and accurate to the best of my knowledge. Owner/Applicant Signature(s) Date Costs of Legal Notice in the Newspaper are paid by the Applicant. ---PAGE BREAK--- CERTIFICATION OF NOTICE PURSUANT TO C.R.S. 24-65.5-103 The undersigned do(es) hereby certify that an examination of the records in the office of the County Clerk and Recorder was made in accordance with C.R.S. 24-65.5-103 et seq. and (check applicable box and fill in the information) Thereafter, on 20__, which is not less than thirty (30) days before the date scheduled for the initial public hearing, or, which is not less than thirty (30) days before the date of submittal of an application for staff action, on the application for the development known as notice was sent, by first class mail, to the below-named mineral right owner(s) as listed in the records of the County Clerk and Recorder, containing the time and place of the initial public hearing, or the date of submittal of an application for staff action and contact information of the Community Development Department, the nature of the hearing or staff action, the location and legal description of the property that is the subject of the hearing or staff action, and the name of the applicant(s). Listing of Mineral Right Owner(s): Name(s): Address: Such records do not identify any mineral right owners. Development Applicant’s Signature Surface Owner’s Signature Print Name Print Name Acknowledgment Acknowledgment State of Colorado ) State of Colorado ) County of ) ss County of ) ss The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this day of , 20 A.D. by me this day of , 20 A.D. by of of as Applicant of the property described hereon. as Owner of the property described hereon. Witness my hand and official seal. Witness my hand and official seal. My commission expires . My commission expires . Notary Public Notary Public FAILURE TO PROVIDE THIS CERTIFICATION, INDICATING COMPLIANCE WITH C.R.S. 24-65.5-103 ET SEQ., IS LIKELY TO RESULT IN A CONTINUANCE OF THE HEARING OR STAFF ACTION.