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For County Use Only Planning Department Confirmation of Current Zone District: Print Full Name PARK COUNTY APPLICATION FOR SPECIAL USE PERMIT FOR WETLAND ACTIVITY NON-REFUNDABLE APPLICATION FEE: $1700 All applicants must submit one complete application and attend a pre-application conference with the Park County Planning Department Staff seven to ten (10) working days prior to the application submittal deadline. Following the acceptance of the complete application the applicant must submit twenty-five (25) collated copies or electronic media as requested to the Park County Planning Department on or before the application submittal date. 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: City: Email Address: Telephone Owner’s Mailing Telephone B. PROPERTY INFORMATION Complete Legal Description of Property Proposed for the Special Use Permit for Wetland Activity (attach additional page, if necessary): Street Address of Property: Property’s Total Acreage: Current Zone District of Property: ---PAGE BREAK--- Page 2 of 11 Special Use Permit Wetland Activity – Revised October 2025 Requirements for a Special Use Permit Article VII, Division 9, Section 7-908 C. APPLICATION REQUIREMENTS 1. Application Fee. An application fee in the amount of $670 must be paid at the time of submission of the application. Make the check or money order to: Park County Planning Department. The fee pays for a portion of the total cost to the County to process the application. Any associated fee that may occur is the applicant’s responsibility. 2. Tax receipt-showing payment of current taxes. This can be obtained at the Park County Treasurer’s office. 3. Proof of ownership in the form of a recorded Warranty Deed. This can be obtained at the Park County Clerk and Recorders office. 4. A legal description of the property prepared by a licensed Colorado land surveyor. 5. A signed and notarized certification from the Applicant that proper notice has been provided to the mineral estate owner pursuant to and in accordance with C.R.S. § 24-65.5-103, or a certification that such notice is not required because the surface estate has not been separated from the mineral estate for the property described in the application. A form of certification is provided in Appendix B (attached). 6. A list of names and mailing addresses of all owners of adjacent property to the property subject to the proposed Special Use Permit, this information is at the Park County Assessor’s Office. 7. A copy of a wetlands delineation report that has been prepared by a certified wetlands delineator. 8. A copy of any agreements, conveyances, restrictions, or private covenants that currently govern or proposed for recordation to govern the use of the site for the proposed Special Use Permit. 9. A site plan containing a graphic representation of the property subject to the proposed Special Use Permit prepared at a commonly used engineering scale. This site plan shall include or illustrate: a. A general vicinity map of the property subject to the Special Use Permit, illustrating the property’s location within the County; b. Date of preparation, map scale, north arrow, and revision box; For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 3 of 11 Special Use Permit Wetland Activity – Revised October 2025 c. Name, address and telephone number of the Applicant and land owner(s), planner, engineer, and surveyor; d. A title that prominently identifies the phrase “Special Use Permit Site Plan”; e. Approval certification and plat language Forms A-1, A-2, A-3, and A-4, as identified in Appendix A of the Land Use Regulations. The Board of County Commissioners may modify the form of certification and plat language upon the advice of the County Attorney; f. Location and type of natural features of the property subject to the Special Use Permit and for properties within 500 feet of the proposed structure(s), including current wetland boundaries, watercourses, lakes, topography, 100 years floodway and floodplain, rock outcrops/surface geology, wildlife corridors and known wildlife foraging. and significant trees and vegetation; g. Location of all existing and proposed structures, utilities, streets, driveways, ditches, fences, or other physical improvements on the property or within 500 feet of the property subject to the Special Use Permit; h. The County may request any other information essential to the evaluation of the proposed Special Use. 10. Special Use Proposal. Written and graphic descriptions that identify or provide the following information: a. The size, height, materials, style, and color of the structures, buildings, vehicle and pedestrian access, utilities, and other improvements proposed for construction within the affected wetlands. Both plan and elevation views at a commonly used engineering or architectural scale must be provided; b. The extent and scope of the grading, filling, dredging, or draining of all or any part of portion of the wetland; c. A description of measures that will be taken to reduce the impact of the proposed activity on the wetland or wetlands and measures proposed to compensate for any loss of wetland functions and values on acreage; d. A general description of the extent and type(s) of vegetative cover of the wetland area, animals known to be common to the wetland, and the hydrological function of the wetland; e. The purpose of the project and an explanation why the proposed activity cannot be located at other sites, including an explanation of how the proposed activity is dependent upon wetlands or water related resources. 11. The Planning Director/County designee may require additional information as deemed necessary to evaluate the proposed use in terms of the purpose of this Division. 12. The property must be clearly identified with the address and posted according to the Park County address requirements (attached). Note: Refer to Park County Land Use Regulations Article VII, Standards for Approval of a Wetland Special Use Permit.) For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 4 of 11 Special Use Permit Wetland Activity – Revised October 2025 D. APPLICANT AND LANDOWNER SIGNATURES: The undersigned applicant and landowner hereby verify and affirm 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 Park County Planning Department 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 PLANNING COMMISSION HEARINGS WILL BE SCHEDULED FOR THE SECOND WEDNESDAY 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 ---PAGE BREAK--- Page 5 of 11 Special Use Permit Wetland Activity – Revised October 2025 APPENDIX A (Form A-1 thru A-8 to be completed on Survey and Mylar Plats only) FORM A-1: LEGAL DESCRIPTION AND CERTIFICATE OF OWNERSHIP LEGAL DESCRIPTION: (“Owner/s”) being the owner(s) of the real property of acres located in Park County, Colorado, descried as follows: [Insert surveyed property description of entire bounds of area being platted] In Witness Whereof, we do hereunto set our hands and seals this ___day of [Printed Name of Owner] [Printed Name of Owner] (If by corporation, a president sign, secretary attests and corporate seal is affixed) STATE OF ) ss. COUNTY OF Acknowledged before me this day of 20__, Notary Public Witness my hand and official seal. My Commission FORM A-2: SURVEYOR’S CERTIFICATE. SURVEYOR’S CERTIFICATE: I hereby certify that the survey and plat of the real property shown and described hereon were made by me or under my direct responsibility, supervision, and checking, in strict compliance with Colorado statures, and that both survey and plat are true, accurate and complete. [Insert if applicable statement by the land surveyor explaining how bearings were determined] [Insert if applicable statement by the land surveyor indicating the type of monuments used.] [Insert any required statement by the land surveyor certifying compliance with applicable provisions of the Colorado Revised Statutes] Colorado License No. Registered Land Surveyor Date: ---PAGE BREAK--- Page 6 of 11 Special Use Permit Wetland Activity – Revised October 2025 FORM A-3: APPROVAL FORM FOR BOARD OF COUNTY COMMISSIONERS APPROVAL BY BOARD OF COUNTY COMMISSIONERS: APPROVED by the Park County Board of County Commissioners, this day of 20__ subject to the provision that the County shall not undertake the maintenance of dedicated public streets, roads, and thoroughfares until satisfactory construction thereof by the subdivider. Said public streets, roads, and thoroughfares will be accepted by resolution at a regular county Commissioners’ meeting after completion, inspection, by Park County, and certification of construction in accordance with County standards. ATTEST: Park County Clerk and Recorder Chairperson FORM A-4: RECORDER’S CERTIFICATE RECORDER’S CERTIFICATE: This plat was filed for record in the office of the County Clerk and Recorder of Park County, on the day of 20__, and duly filed at Reception Park County Clerk and Recorder FORM A-5: TITLE COMPANY CERTIFICATE OF OWNERSHIP TITLE CERTIFICATE: Title Insurance Company hereby certifies that title to the above- described property is vested in the Owner(s). [Signature of Authorized Agent] FORM A-6: MORTGAGEE CONSENT TO DEDICATION MORTGAGEE CONSENT TO DEDICATION: The undersigned holders of mortgage interests and liens against the property offered for dedication and for transfer to the public and to Park County consents and approves of such dedication and transfer and subordinates and release its interests to such dedicated and transferred property In Witness Whereof, we do hereunto set our hands and seals this day of 20__ [Printed Name of Mortgage Interest Holder] (If by corporation, a president sign, secretary attests and corporate seal is affixed.) [Insert notarization conforming to applicable requirement of state law for mortgage’s place of execution] ---PAGE BREAK--- Page 7 of 11 Special Use Permit Wetland Activity – Revised October 2025 FORM A-7: COUNTY SKETCH PLAN OR PRELIMINARY PLAN APPROVAL PARK COUNTY APPROVAL APPROVED as a [insert either: Sketch Plan or Preliminary Plan] by the Park County Board of County Commissioners, this ___day of 20__ subject to all applicable provisions of the Park County Land Use Regulations. ATTEST: Park County Clerk and Recorder Chairperson FORM A-8: COUNTY ADMINISTRATIVE APPROVAL PARK COUNTY ADMINISTRATIVE APPROVAL: APPROVED as an Administrative Plat Amendment by the Planning Director of Park County Colorado and approved for recordation with the Park County Clerk and Recorder’s Office pursuant to the Park County Land Use Regulations this day of ATTEST: Planning Director/County Designee Park County Clerk and Recorder ---PAGE BREAK--- Page 8 of 11 Special Use Permit Wetland Activity – Revised October 2025 APPENDIX B APPLICANT CERTIFICATION REGARDING NOTICE TO MINERAL ESTATE OWNER I, submitted an application for land use approval from Park County generally described as: Conditional Use Permit Determination of Location and Extent of Public Facilities Use Planned Unit Development with Rezoning Special Use Permit; (Telecommunications, Wetlands) Subdivision; (Major Preliminary Plan, Major Final Plat, Minor, Sketch, Combined) I understand that state law, found at CRS 24-65.5-101 through 24-65.5-104, imposes specific legal requirements involving my providing written notice to the mineral estate owner of my application. I HEREBY CERTIFY that I have complied with the notice requirements imposed upon me by CRS 24-65.5-101 through 24-65.5-104. Signature of Applicant Print Name For County Use Only Application Name/Case ---PAGE BREAK--- Page 9 of 11 Special Use Permit Wetland Activity – Revised October 2025 APPENDIX C AFFIDAVIT OF UNDERSTANDING I, the undersigned applicant, hereby acknowledge and agree to the following terms and conditions related to the submission of my application to the Park County Development Services Department. 1. ACKNOWLEDGMENT OF APPENDIX C REQUIREMENTS: I understand that, pursuant to Appendix C – Development Review Fees of the Park County Land Use Regulations, all application fees are non-refundable once an application has been received by the County, regardless of its status or outcome. 2. RESPONSIBILITY FOR COMPLETENESS: I acknowledge that it is solely my responsibility to ensure that all required materials, forms, maps, and supporting documentation are submitted in full compliance with the applicable Land Use Regulations and departmental procedures. 3. INCOMPLETE, WITHDRAWN, OR DENIED APPLICATIONS: I understand that any application that is incomplete, withdrawn, or denied—whether administratively or by action of the Board of County Commissioners—shall not be eligible for reimbursement, credit, or transfer of any portion of the fee paid. Any subsequent or corrected submittal shall constitute a new application and require payment of the applicable fee as set forth in Appendix C. 4. CERTIFICATION: I affirm that I have read and fully understand this affidavit and the non- refundable nature of the application fee as described in Appendix C. I further acknowledge that this affidavit shall be retained as part of the official record of my application. Applicant Name: Mailing Address: Project Name / Type: Signature of Applicant Print Name STATE OF ) ss. COUNTY OF Acknowledged before me this day of 20__, Notary Public Witness my hand and official seal. My Commission Expires: ---PAGE BREAK--- Page 10 of 11 Special Use Permit Wetland Activity – Revised October 2025 “POSTED” ADDRESS REQUIREMENTS Park County Land Use Regulation Section 7-1207 Address Number Signage Park County requires properties undergoing development to have a permanent address posted. This address post is permanent and is not just for the inspector but is for the use of the Fire Department, Sheriff and Emergency Services. The street address numbers need to be posted on the property prior to the preliminary inspection of the driveway. Numbers shall be attached to a 4” X 4” treated wood or redwood post. The post shall be placed at the driveway no further than 5 feet from the property line. Note: The post must not be placed in the county road right-of-way. The top of the post shall be installed, in a permanent fashion, a minimum of 48 inches above the ground. If the ground is frozen, place the post in a 5 gallon bucket filled with sand or rock until the post can be permanently installed into the ground. The sign specifications are shown with the below two examples. * Note: Contact your local Fire Protection District for signage information Type of Sign specifications for numbers is attached. 1 2 3 4 *Numbers attached to both sides of post 1 2 3 4 ---PAGE BREAK--- Page 11 of 11 Special Use Permit Wetland Activity – Revised October 2025 SIGN SPECIFICATIONS Standard Size - 6” x 18” Standard Color – Green Background with White Reflective Numbers