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Page 1 of 11 Common Plat Amendment – Revised October 2025 For County Use Only Planning Department Confirmation of Current Zone District: Print Full Name PARK COUNTY APPLICATION FOR COMMON PLAT AMENDMENT 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 one paper copy 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 or e-mail [EMAIL REDACTED]. A. APPLICANT AND OWNERSHIP INFORMATION Applicant’s Name: Mailing Address: City: Telephone Owner’s Mailing Address: City: Telephone B. PROPERTY INFORMATION Complete Legal Description of Property Proposed for the Common Plat Amendment (attach additional page, if necessary): Street Address of Property: Property’s Total Acreage: Current Zone District of Property: ---PAGE BREAK--- Page 2 of 11 Common Plat Amendment – Revised October 2025 Requirements for a Common Plat Amendment Article VI, Division 5, Section 6-503 C. APPLICATION REQUIREMENTS 1. Application Fee. An application fee in the amount of $1700 must be paid at the time of submission of the application. Make the check or money order payable to: Park County Planning Department. The fee pays for the typical cost to the County to process the application. Any additional costs that may occur are 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 proposed for the plat amendment prepared by a licensed Colorado land surveyor. 5. A list of names and mailing addresses of all owners of adjacent property to the property subject to the proposed plat amendment, this information is at the Park County Assessor’s Office. 6. For a Common Plat Amendment that relocates or reconfigures one or more lot lines within the subdivision, a Plat illustrating the amendment. The Plat shall be drafted at a commonly used engineering scale by the use of permanent ink on a stable reproducible drafting medium with outer dimensions of twenty-four inches by thirty-six inch (24" x 36"). Where the required data cannot be clearly shown on one plan sheet, additional plan sheets of the same size may be used with easily identifiable match lines. The Plat shall contain: a. A title that prominently identifies the name of the recorded subdivision, together with the phrase "Plat Amendment." If the property described in the recorded plat is zoned as a Planned Unit Development (PUD), the title shall include the phrase “Planned Unit Development”; b. Date of preparation, map scale, and north arrow; c. Name, address and telephone number of the Applicant, land owner(s), planner, engineer, and surveyor; d. A general vicinity map illustrating the location of the property subject to the proposed amendment; e. Total acreage and surveyed description of the lots and area subject to the proposed amendment; f. A clear illustration or description of the amendment proposed, using shading, crosshatching, highlighting, or other techniques to accurately illustrate the proposed amendment; For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 3 of 11 Common Plat Amendment – Revised October 2025 g. Approval certification and plat language Forms A-1, A-2, A-3, A-4, and A-5, and A-6 if applicable 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. 7. For a Common Plat Amendment that modifies, amends, adds, or deletes a restriction, limitation, condition, or other obligation, right, or duty stated on the recorded plat, a written description clearly stating the proposed amendment in a form suitable for recordation with the office of the Park County Clerk and Recorder. The written description shall be subject to approval of the County Attorney and, at a minimum, the written amendment shall also include: a. A title that prominently identifies the name of the recorded subdivision together with the phrase "Plat Amendment.” If the property described in the recorded plat is zoned as a Planned Unit Development (PUD), the title shall include the phrase "Planned Unit Development"; b. Date of preparation, name, address, and telephone number of the Applicant, land owner(s), and any professionals (planners, engineers, surveyors) assisting in the plat amendment; c. As appropriate for the scope and extent of the proposed Common Plat Amendment, approval certification and plat language forms A-1, A-2, A-3, A-4, and A-5 as identified in Appendix A of the Land Use Regulations. The Board of County Commissioners may modify the form of certification and plat language. 8. Letters of consent to alter or vacate utility easements from all public utilities serving the site, if applicable. 9. The property must be clearly identified with the address and posted according to the Park County address requirements (attached). 10. A $43.00 check made out to the Park County Clerk and Recorder to record the surveyors Mylar. Note: A Mylar as described in #6 will be required after final approval for recording. Note: Refer to Park County Land Use Regulations Article VI Standards for Approval of a Common Plat Amendment. For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 4 of 11 Common Plat Amendment – 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 TWO PUBLIC HEARINGS. 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 Common Plat Amendment – 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 Common Plat Amendment – 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 Common Plat Amendment – 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 Common Plat Amendment – 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 9 of 11 Common Plat Amendment – Revised October 2025 THE FOLLOWING IS A LIST OF UTILITY COMPANIES THAT YOU MAY NEED TO CONTACT TO GET YOUR UTILITY RELEASE LETTER FOR #4 OF THE APPLICATION REQUIREMENTS IREA Brooks Kaufman (720) 733-5403 [EMAIL REDACTED] XCEL Loren Vawser (970) 262-4034 [EMAIL REDACTED] CENTURYLINK Murk Mansell (719) 584-6484 [EMAIL REDACTED] ---PAGE BREAK--- Page 10 of 11 Common Plat Amendment – 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 Common Plat Amendment – Revised October 2025 SIGN SPECIFICATIONS Standard Size - 6” x 18” Standard Color – Green Background with White Reflective Numbers