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For County Use Only Planning Department Confirmation of Current Zone District: Print Full Name PARK COUNTY APPLICATION FOR MINOR SUBDIVISION 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 (10) ten 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, or 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 Minor Subdivision Plat (attach additional page, if necessary): Street Address of Property: Property’s Total Acreage: Current Zone District of Property: ---PAGE BREAK--- Page 2 of 11 Minor Subdivision – Revised October 2025 Requirements for a Minor Subdivision Plat Article VI, Division 3, Section 6-301 C. APPLICATION REQUIREMENTS 1. Application Fee. An application fee in the amount of $1700 ($2550 if combined with rezoning) 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 for the property proposed for subdivision. This can be obtained at the Park County Treasurer’s office. 3. Evidence of ownership and Encumbrances as defined in Article IV of the Land Use Regulations. 4. A legal description of the property proposed for subdivision 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 adjacent property owners to the property proposed for subdivision, this information is at the Park County Assessor’s Office. 7. A Minor Subdivision Plat. The Minor Subdivision Plat shall be drafted at a commonly used engineering scale by the use of permanent ink on stable reproducible drafting medium with outer dimensions of twenty-four by thirty-six inches (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 Minor Subdivision Plat must also be submitted in a digital format that will allow the Mapping Department to accurately reference it into the County’s Geographic Information System. At a minimum, the Minor Subdivision Plat shall contain: a. A title that prominently identifies the proposed name of the subdivision together with the phrase “Minor Subdivision Plat”; 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; For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 3 of 11 Minor Subdivision – Revised October 2025 d. A general vicinity map illustrating the location of the property proposed for subdivision; e. Total acreage and surveyed legal description of the area; f. Primary boundary survey control points with monument descriptions; all parcel and right-of-way lines dimensioned with curve data including chord and bearings; basis of bearings and relation to true meridian. All required boundary monuments shall be placed in the field before the Minor Subdivision Plat is recorded; g. Tract boundary lines, road right-of-way lines, easements and other sites with accurate bearings and dimensions including chord and bearings, central angles, arc and radii of all curves; h. Name and right-of-way width of each road. Right-of-way widths are to be shown at each leg of an intersection, at points of curvature and tangency, at dead-ends, and at angle points; i. Location, dimensions, and purposes of all existing or proposed easements; j. Number or letter to identify each Lot and Outlot. Lots shall be numbered. Outlots shall be lettered. The Plat shall include sufficient information to designate and restrict the use of any outlot to the Outlot’s intended purpose k. An identification of the easements, rights-of way, and any other public facilities shown on the plat to be dedicated to public use, subject to acceptance by the Board of County Commissioners. No areas within the Minor Subdivision Plat may be designated as areas of conditional, planned, or future public acquisition. Dedications of public property not made on the Minor Subdivision Plat shall be made only by General Warranty Deed recorded contemporaneously with the Minor Subdivision Plat unless otherwise approved by the Board of County Commissioners; l. Names of all adjoining subdivisions with dotted lines of abutting lots. If the adjoining land is unplatted, it should be shown as such with the owner’s names; m. Signature and seal of the licensed land surveyor; n. A delineation of the extent of the one hundred (100) year flood plain and any wetlands, if applicable according to the Planning Director or Designee; o. Approval certifications and plat language Forms A-1, A-2, A-3, A-4, A-5 and A-6 as identified in Appendix A of these Land Use Regulations. The Board of County Commissioners may modify the form of certification upon the advice of the County Attorney. 8. A copy of any agreements, conveyances, restrictions, or covenants that currently govern or are proposed for recordation to govern the use and maintenance of the subdivision and any common open space or subdivision amenity. 9. A report and descriptive plan identifying the means by which water and wastewater services will be provided to each proposed lot within the property proposed for minor For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 4 of 11 Minor Subdivision – Revised October 2025 subdivision. Such report or descriptive plan shall include evidence that a water supply that is sufficient in terms of quality, quantity and dependability will be available to ensure an adequate supply of water for the type of subdivision proposed and shall meet the requirements of Article VII, Divisions 7 and 8 of these Land Use Regulations. All subdivisions proposing the use of five or more individual wells shall submit to the County an analysis prepared by a professional deemed qualified by the County to evaluate water delivery systems that compares the efficiency, cost effectiveness, and adverse impacts upon other wells of the proposed individual wells to the efficiency, cost effectiveness, and adverse impacts of a common or community water delivery system(s). 10. A drainage, erosion, and sedimentation plan as described in Article VII, Division 6 of these Land Use Regulations. 11. If deemed applicable by the Planning Director/County Designee, either a wildfire hazard mitigation plan approved by the local fire protection district or a letter from the local fire protection district saying that no such plan is necessary. 12. Only where Public Improvements are proposed to serve the subdivision, the Applicant shall also deliver: a. Preliminary engineering plans and specifications for all Public Improvements in a form sufficient to enable final engineering and construction plans to be prepared within thirty (30) days following the Minor Subdivision Plat approval. Substantive changes between the preliminary and final plans will require Board of County Commissioners approval and will be subject to the Standards for Approval in Section 6-303. b. A written description of arrangements and financial institution commitments for providing financial guarantees and sureties for the timely completion of all Public Improvements. For example, a letter of commitment from a financial institution to issue an irrevocable letter of credit upon approval of the Minor Subdivision Plat. c. A preliminary or draft Subdivision Improvements Agreement (SIA) in the general form provided by Appendix J of these Subdivision Regulations. In order to ensure timely processing of the application, Applicants are strongly encouraged to first submit a draft form of SIA to the County Attorney for review and revision prior to submitting the application for the Minor Subdivision. The Board of County Commissioners shall revise the SIA into a form capable of finalizing upon the conclusion of the public hearing and approval or conditional approval of the Minor Subdivision Plat. 13. The Planning Director may require 1041 Permits if the development warrants any such permits. For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 5 of 11 Minor Subdivision – Revised October 2025 14. Applicants are strongly encouraged to submit with the application additional documentation and information to demonstrate that the proposed subdivision will satisfy the Standards for Approval contained in Section 6-303. 15. The Planning Director, Planning Commission and/or Board of County Commissioners may require the Applicant’s submission of other studies and reports prepared by a qualified professional at the Applicant’s cost to address issues such as, but not limited to: drainage, grading, traffic, soils and geology, utilities services, and radiation or environmental hazards. Any decision of the Planning Director pursuant to this paragraph may be appealed to the Board of County Commissioners in accordance with Article III, Division 2 of these Land Use Regulations. 16. An $43.00 check made out to the Park County Clerk and Recorder to record the surveyors Mylar. The following is necessary if the proposed subdivision includes an application for rezoning: 17. One or more maps showing the following: a. The current zone district(s) of the property to be rezoned and the adjacent properties b. A description of the existing uses on the property and on adjacent properties c. Topography of the property shown in elevation contours of not greater than ten (10) foot increments, or any other increment deemed appropriate by the Planning Director, d. Points of access to the property, internal roads and trails including widths and approximate grades, illustrating how such access is obtained, e. Where any access to the property subject to rezoning is obtained from a private road, trail easement, driveway, or other private access, the applicant shall provide evidence of permanent legal right of access. f. Natural features of the property, wetlands, floodplain, riparian areas, water bodies, rock outcroppings, significant vegetation and slopes greater than 25% g. Utility systems including existing and proposed wells, septic and electric services. Note: Refer to Park County Land Use Regulations Article VI, Standards for Approval of a Minor Subdivision. Note: A Mylar as described in #8 will be required after final approval for recording. For County Use Only: Initial Receipt of the Required Information ---PAGE BREAK--- Page 6 of 11 Minor Subdivision – Revised October 2025 D. APPLICANT AND LANDOWNER SIGNATURES: The undersigned applicant and landowner 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 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 7 of 11 Minor Subdivision – Revised October 2025 APPENDIX A 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] [If applicable, insert the following:] DEDICATION: KNOW ALL MEN BY THESE PRESENTS THAT THE Owner(s) of the land described above have caused the land to be laid out and platted under the name of And do herby dedicate, grant, and convey to the public forever and in fee simple all streets, alleys, roadways, thoroughfares, fire lanes, utility and drainage easements, park land, and open space as indicated or illustrated on this plat in compliance with the Park County Land Use Regulations and the landowners shall bear all expense involved in planning, design, and construction of all public improvements except to the extent expressly stated in any County-approved and recorded Subdivision Improvement Agreement. Dedication shall be final upon adoption of a resolution by the Board of County Commissioners accepting the property dedicated by this plat. Except as otherwise stated on this plat, there shall be no limitation or restriction upon the purpose or public use of property dedicated by this plat. [Where applicable] Those areas designated as “outlots” are herby excluded from any development and are reserved for potential or possible future subdivision except as may be expressly stated in a County-approved subdivision improvements agreement. Any future use and development of any outlot shall require further subdivision and County-approval in accordance with the Park County Subdivision Regulations. 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, president signs, 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 Expires: ---PAGE BREAK--- Page 8 of 11 Minor Subdivision – Revised October 2025 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 statutes, 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: FORM A-3: APPROVAL FORM FOR BOARD OF COUNTY COMMISSIONERS APPROVAL BY BOARD OF COUNTY COMMISSIONERS: APPROVED as a Minor Subdivision by the Park County Board of County Commissioners, this ____day of 20__ subject to all applicable provisions of the 2009 Park county Land Use Regulations, as amended. [If applicable, insert the following:] 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. BOCC Chairperson Park County Clerk and Recorder 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 ---PAGE BREAK--- Page 9 of 11 Minor Subdivision – Revised October 2025 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 DEDICTION 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 releases its interests to such dedicated and transferred property In Witness Whereof, we do hereunto set our hands and seals this ____day of [Printed Name of Mortgage Interest Holder] (If by corporation, president signs, secretary attests and corporate seal is affixed) [Insert notarization conforming to applicable requirement of state law for mortgagee’s place of execution.] ---PAGE BREAK--- Page 10 of 11 Minor Subdivision – 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 11 of 11 Minor Subdivision – 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: