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For County Use Only Planning Department Confirmation of Current Zone District: Print Full Name PARK COUNTY APPLICATION FOR APPEAL OF ADMINISTRATIVE INTERPRETATION OR DECISION NON-REFUNDABLE APPLICATION FEE: $550 NOTE: APPEAL MUST BE FILED WITHIN TEN (10) DAYS OF DENIAL The Park County Board of County Commissioners at a public hearing hears an Appeal of Administrative Decision application. In order to process your application, the Chief Administrative Officer to the Board of County Commissioners must have one original and four collated copies of the following information within ten (10) days after the date of the written administrative interpretations or decision. If you have questions regarding this form please contact the Planning Department by phone at (719) 836-4292, e-mail [EMAIL REDACTED], fax (719) 836- 4351, or write to us at P.O. Box 1598 Fairplay, CO 80440 A. APPLICANT AND OWNERSHIP INFORMATION Applicant’s Name: Mailing Address: Telephone Owner’s Mailing Telephone No. and Email B. PROPERTY INFORMATION Complete Legal Description of Property subject to the Administrative Interpretation or Decision (attach additional page, if necessary): Street Address of Property’s Total Current Zone District of ---PAGE BREAK--- Page 2 of 3 Appeal of Administrative Decision –Revised April 2013 Requirements for an Appeal of Administrative Decision Article III, Division 2, Section 3-204 C. APPLICATION REQUIREMENTS 1. Application Fee. An application fee in the amount of $530 must be paid at the time of submission of the application. Make the check or money order payable to: Park County Board of County Commissioners. The fee pays for the typical cost to the County to process the application including the cost of publication of the necessary public notices. Any additional costs that may occur are the applicant’s responsibility. 2. A copy of the written administrative interpretations or decisions being appealed. 3. A written description of the reasons justifying the appeal. 4. Any other documentation deemed appropriate by the Applicant. Note: Refer to Park County Land Use Regulations Article III for Appeal regulations. For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 3 of 3 Appeal of Administrative Decision –Revised April 2013 D. APPLICANT AND LANDOWNER SIGNATURES: The undersigned applicant and landowner(s) hereby verifies and affirms that the information contained in this application is complete and accurate. The undersigned applicant and landowner understands and acknowledges that the submission of inaccurate and incorrect information may result in the denial or rejection of the application and/or result in the invalidation of any approvals issued by Park County, Colorado. Applicant: Signed: Print name: If company, state Title/Position: E. VERIFICATION OF DATE OF DELIVERY OF APPLICATION This application was submitted to the Chief Administrative Officer on the following date and time: Month Day Year Payment of the Applicant Fee was made by: Personal Check Amount $ Cash Amount $ Amount $ APPLICANT MUST ATTEND THE HEARING. IF A REPRESENTATIVE ATTENDS THE HEARING ON BEHALF OF THE APPLICANT, A NOTARIZED LETTER OF CONSENT MUST ACCOMPANY THE APPLICATION. ALL BOARD OF COUNTY COMMISSIONER HEARINGS WILL BE SCHEDULED FOR THE THIRD THURSDAY OF EVERY MONTH. IF A QUORUM IS NOT AVAILABLE, THE HEARING WILL BE SCHEDULED THE NEXT AVAILABLE DATE. For County Use Only: Verification of Date of Delivery and County Receipt of Application Print