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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 TELECOMMUNICATION FACILITIES NON-REFUNDABLE APPLICATION FEE: $2000 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. 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- 4268, 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 Tower Owner’s Mailing Telephone Land Owner’s Mailing Telephone B. PROPERTY INFORMATION Complete Legal Description of Property Proposed for the Special Use Permit for Telecommunications Facility (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 Telecommunications Facility – Revised October 2025 Requirements for a Special Use Permit Article V, Division 9, Section 5-903 C. APPLICATION REQUIREMENTS 1. Application Fee. An application fee in the amount of $2000 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 including the cost of publication of the necessary public notices. 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. Evidence of Ownership and Encumbrances for the property on which the Telecommunication Site is proposed. 4. A legal description of the property on which the Telecommunication Site is proposed, 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 within seven hundred fifty (750) feet of the property subject to the proposed Special Use Permit, this information appears of record with Park County Assessor’s Office. 7. The names, addresses and telephone numbers of all owners of other Telecommunications facilities within a six mile radius of the proposed new facility. 8. A sworn and notarized affidavit attesting to the fact and describing the Applicant’s diligent, but unsuccessful, efforts to obtain permission to install or collocate the Applicant’s proposed Telecommunications facilities on other Telecommunication facilities located within a six mile radius of the proposed site or attesting to the fact and describing, in detail, why such collocation would be technologically impossible. Documentation evidencing diligence in seeking permission and the denial of such permission or documentation of the technological impossibility of collocation, as the case may be, shall be included with the affidavit. For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 3 of 11 Special Use Permit Telecommunications Facility – Revised October 2025 9. A site plan containing a graphic representation of the property subject to the proposed Special Use Permit prepared at a commonly used engineering or architectural 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; and, b. Date of preparation, map scale, north arrow, and revision box; and, c. A title that prominently identifies the name of the Applicant and the phrase “Special Use Permit Site Plan.”; and, d. Information identifying all Telecommunication Facilities, setbacks, maximum heights, proposed conditions or restrictions upon use, and relevant requirements and restrictions applicable to the zone district(s) in which the property subject to the proposed Special Use Permit is located, as identified in the Land Use Regulations; and, e. A signature block that reads: BOARD OF COUNTY COMMISSIONERS APPROVAL: The Park County Board of County Commissioners by Resolution No. approved this Site Plan and a Special Use Permit for the illustrated Telecommunication Facility on the of Attest Chairperson Park County Clerk and Recorder f. Location and type of natural features within seven hundred and fifty (750) feet of the proposed Telecommunications Facility including watercourses, lakes, topography at not more than ten foot (10ft) vertical intervals, one-hundred (100) years floodplain, wildlife corridors and known wildlife foraging areas, and significant trees and vegetation; and, g. Location of all existing man-made structures, utilities, streets, driveways, ditches, fences, or other physical improvements within seven hundred and fifty (750) feet of the proposed Telecommunication Facility; and, h. Approximate locations of recorded easements or rights-of-way on the property and within seven hundred and fifty (750) feet of proposed Telecommunication Facility; and, i. Location of vehicular or pedestrian access to the Tower and/or Antenna, equipment, and Support Facilities; and, j. The County may request any other data or information essential to the evaluation of the proposed special use. 10. Special Use Proposal. Illustrations, maps photographs, and textural descriptions, which identify or provide the following information: For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 4 of 11 Special Use Permit Telecommunications Facility – Revised October 2025 a. A written evaluation and report of the visual impact of the proposed facility, including color photographic simulations of the proposed site of the proposed Telecommunications Facility as it would appear from at least three different locations near the facility and legally accessible to the public. The Planning Commission or the Board of County Commissioners may request additional simulations to assess the visual impact of the proposed Telecommunications facility. Applicants are encouraged to provide photographic examples of similar facilities and samples of proposed architectural colors and materials to permit the County and interested parties to understand the visual impact of the proposed special use. The report or evaluation shall include a landscape, screening, and fencing plan showing specific landscape materials and locations, fencing materials and colors, and other screening techniques together with illustrative drawings or photographic simulations showing the visual effect of the proposed landscaping and screening from at least three different locations near the facility and legally accessible to the public; and, b. Architectural elevation drawing of at least two sides of the proposed Telecommunications Facility; and, c. A technological design plan for the proposed Telecommunication facility. The design plan shall identify the type of telecommunication service to be provided by the Telecommunication site, the frequency or bandwidths, a general description of the equipment types and models, and a graphic representation of the area to be provided service by the Telecommunication Facility; and, d. A copy of any lease or other agreement(s) authorizing the use of the property for the proposed Telecommunication facility. Applicants may excise or delete from such lease or agreement(s) information considered proprietary or pertaining to rental or lease payment amounts; and, e. Description of the size, type, and visibility of any proposed illumination for this site, specifically including lighting attached to any Tower; and, f. Information sufficient to demonstrate that the Telecommunications site is a necessary component of the Applicant’s overall communication network and is integrated into a coordinated communication service plan for the community and for the area. Conformance with this requirement may be established by evidence presented to the County which demonstrates that the proposed site is necessary in order to: i. provide appropriate signal coverage and quality to the area; ii. connect and to relay services between existing facilities; iii. connect and relay services between facilities that are reasonably likely to be constructed within one-hundred eighty (180) days of the application; iv. handle increased capacity due to customer demand; v. overcome existing topography and/or structures in the surrounding area that preclude other preferred locations in the same area; or For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 5 of 11 Special Use Permit Telecommunications Facility – Revised October 2025 vi. overcome engineering and technical constraints which require the site to be in the desired location in relation to other existing sites and potential site locations; and, g. Information sufficient to demonstrate that location of the proposed Antenna and facility upon Towers or structures at other existing Telecommunication Sites and Facilities have been thoroughly explored and are rendered impossible due to one or more of the following: i. absence of other existing telecommunication sites within the area; ii. incompatibility of an engineering or technical nature between the Applicant’s proposed Antenna and Telecommunication Service and existing Telecommunication Sites and Facilities; iii. lack of sufficient space on existing Telecommunication Sites to permit attachment of the Applicant’s proposed Antenna or equipment; iv. inability to obtain a lease for or permission to use existing Telecommunication Sites despite the exercise of due diligence to do so. h. Evidence that the Telecommunications Provider has obtained or secured a performance bond, letter of credit, or other surety (“performance guarantee”) acceptable to the County Attorney in an amount of one-hundred twenty percent (120%) of the estimated cost and expense of removing the Telecommunications facility in accordance with Sections 5-908, 5-909, and/or 5-911. All performance guarantees shall authorized the County to obtain the funds secured by the guarantee upon the County’s determination that the Telecommunications facility has not been removed in accordance with this Division or as otherwise required by law. The amount of such performance guarantee shall be based upon an estimate obtained by the Telecommunications service provider, which shall be subject to review and approval of the County. In the event that the County rejects an estimate as inaccurate, incomplete, or incorrect, the County may obtain, at its cost and expense, an estimate, which shall be used for purposes of determining the amount of the performance guarantee. The Telecommunications service provider shall take all action necessary to keep such performance guarantee valid and in effect at all times. Upon any renewal of the Special Use Permit or modification of an approved telecommunication facility, the Planning Director/County Designee shall cause the performance guarantee to be reviewed, the appropriate amount of the guarantee reassessed, and a new guarantee shall be posted or secured by the service provider in accordance with this subsection. Expiration of a performance guarantee may, at the option of the County and notice to the Telecommunications Provider, result in the expiration of the Special Use Permit for the telecommunication facility. i. Proof of insurance to insure the public against personal and property damage resulting from negligent installation and/or damages caused by or arising from the construction and maintenance of the Telecommunications Facility site. For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 6 of 11 Special Use Permit Telecommunications Facility – Revised October 2025 11. An Environmental Assessment of the proposed action and Wireless Telecommunication Bureau review of the Environmental Assessment, if required by Title 47 of the Code of Federal Regulations, Part 1, Subpart 1, Rule Section 1.1307. 12. The property must be clearly identified with the address and posted according to the Park County address requirements (attached). For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 7 of 11 Special Use Permit Telecommunications Facility – Revised October 2025 D. APPLICANT AND LANDOWNER SIGNATURES: The undersigned applicant, landowner, and tower owner hereby verify and affirm that the information contained in this application is complete and accurate. The undersigned understand and acknowledge 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’s signature: Printed name: If company, state Title/Position: Tower owner’s signature: Printed name: Title/Position: Land owner’s signature: Printed name: 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 8 of 11 Special Use Permit Telecommunications Facility – 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 Telecommunications Facility – 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 Telecommunications Facility – 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 Telecommunications Facility – Revised October 2025 SIGN SPECIFICATIONS Standard Size - 6” x 18” Standard Color – Green Background with White Reflective Numbers