MINOR SUBDIVISION SKETCH PLAN SUBMITTAL CHECKLIST

MINOR SUBDIVISION SKETCH PLAN SUBMITTAL CHECKLIST The Minor Subdivision Sketch Plan is the first step of the three step Minor Subdivision process. The applicant shall submit the minor subdivision sketch plan application fee and the application requirements are stated in Section 24-3-20 of the Weld County Code which can be accessed at www.co.weld.co.us (Quick Links County Code) A conference shall be arranged between the Department of Planning Services and the applicant to discuss the sketch plan and staff comments prior to or in conjunction with the submittal of the Change of Zone application. The Department of Planning Services may request additional information, application packets and/or fees that will aid in the review of the Sketch Plan application. APPLICATION REQUIREMENTS: The applicant shall submit the Minor Subdivision Sketch Plan application fee and the required sketch plan application materials as follows: One digital or electronic copy of completed application materials, if required Legible deed or legal instrument identifying the applicant s interest in the property. Signatures of all fee owners of property must sign this application or if an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be included showing the signatory has the legal authority to sign for the corporation. Minor Subdivision narrative. Narrative shall address Section 24-3-20; items C, D, E, G, H, and J of the Weld County Code. Geotechnical Report prepared by a certified geologist or professional engineer as required by Section 24-3-20.I of the Weld County Code (submittal requirements attached) Statement from the Weld County Treasurer showing no delinquent taxes exist for the original parcel Minor Subdivision vicinity and sketch plan map. Maps shall conform to Section 24-3-20.K and L of the Weld County Code. Application fee Colorado Geological Survey fee Drainage Report Traffic Study Flood Hazard Development Permit (FHDP) Geologic Hazard Development Permit (GHDP) The applicant shall submit 1 packet containing one original of all of the above for a 7 day completeness review. The packet shall be bound with either paper clips or binder clips (no substitutes). Applications bound in any other fashion may be returned to the applicant without review. Updated 10-2017

MINOR SUBDIVISION PROCEDURAL GUIDE APPLICATION FEE HEARINGS/MEETINGS Step 1. Minor Subdivision $2,100.00 Dept. of Planning Services Sketch Plan Colorado Geological Survey *see below Step 2. Minor Subdivision $1,500.00 + $50.00 Weld County Planning Commission Change of Zone per buildable lot Board of County Commission $11.00 Plat recording fee per page Step 3. Minor Subdivision $1,500.00 + $100.00 Weld County Planning Commission Final Plat per buildable lot Board of County Commissioners Utility Advisory Board $13.00 Plat recording fee per page Each Subdivision application and buildable lot will be assessed an additional thirty percent fee if the site is located in an Urban Growth Boundary, Urban development node, Intergovernmental defined growth area, and/or a mixed use land area, also for Urban Scale developments outside an urban area. Fees are non-refundable and due at time of application submittal. Fees are set by the Board of County Commissioners by Resolution. County Staff is not authorized to negotiate fees and cannot, under any circumstance, change, reduce, or amend the fees set forth in the Weld County Planning Fee Schedule. * The application shall be referred to any municipality or county governing body within a three mile radius of the parcel under consideration for a Minor Subdivision * Colorado Geological Survey Application Fees: All Sketch Plan applications will be submitted to the Colorado Geological Survey for review along with the required geologic maps and investigation reports. The following fee shall be collected by the Department of Planning Services at Sketch Plan submittal. As the fee will be forwarded, please make checks payable to the Colorado Geological Survey. Very Small Residential Subdivisions: 1-3 dwellings and <100 acres. Cost = $600.00 Small Subdivision Review: Subdivisions with >3 dwellings and <100 acres. Cost = $950.00 Large Subdivision Reviews: Subdivisions with >100 acres and <500 acres. Cost = $1550.00 Very Large Subdivision Review: Five hundred acres or more. Cost =$2500.00 Although most reviews listed above will fall within the estimated time and costs built into the listed standard charges, it is necessary, in fairness to all users, to provide for those cases that will incur excess review costs. The Colorado Geological Survey will contact the local planner if it is evident that additional review costs will be requested. The applicant is responsible for all fees associated with the geological review. Excess time or travel charges will be made for those expenditures in excess of the normal range of review time (maximum 6.75 hours on small reviews or 8.75 hours for large reviews), or for extensive travel related to a particular case. * An additional investigation fee shall be added to the cost of the permit application when specific land, uses, buildings, manufactured homes, mobile homes, and structures that require a permit by the Weld County Code are located, moved, operated, or constructed prior to obtaining a permit. The investigation fee shall be fifty percent of the fee, established by separate action by the Board of County Commissioners for land-use

PURPOSE applications. The payment of such investigation fee shall not relieve any persons from fully complying with the requirements of the Weld County Code, nor from any other penalties. The purpose of this packet is to provide general information to an applicant about the Minor Subdivision application process. It is not intended to be a substitute for the specific requirements of the Weld County Code, Chapter 24. It is the responsibility of the applicant to be knowledgeable of the specific requirements of the Weld County Code, Chapter 24 for the Minor Subdivision application process. INTENT AND APPLICABILITY The minor subdivision procedure is a process for development and review of subdivisions proposing a maximum of nine lots. The minor subdivision process shall not be used to circumvent the Weld County Code, Chapter 24, by using more than one subdivision to avoid following the major subdivision requirements. An application for a minor subdivision will be presumed to circumvent the Weld County Code, Chapter 24, when the result of approval would be to create more nine minor subdivision lots on parcels under common ownership within a 1,320 (1/4 mile) radius of each other.

Colorado Geological Survey Application/Fees All Plans submitted for review shall be accompanied with a geology report containing information on the specific items herein. This report will be reviewed by agencies to evaluate the area being subdivided or developed. Five copies of this report shall be submitted to the Department of Planning Services, including all supporting documentation, including maps. The soils and geology report shall be prepared by a professional geologist, as defined by State statutes. The following concerns shall be fully addressed: If any of these items are addressed in other reports, refer to these reports appropriately. It is recognized that certain geologic interpretations cannot be firm or complete, at least in advance of grading operations, but it is expected that all pertinent data will be presented fully and clearly, so that interpretations and recommendations can be critically reviewed by others. 1. Mapping A detailed large-scale map normally will be required for a report on a tract, as well as for a report on a smaller area which the geologic relationships are not simple Where three-dimensional relationships are significant but cannot be described satisfactorily in words alone, the report should be accompanied by one or more appropriately positioned structure sections The locations of test holes and specific sources of subsurface information should be indicated in the text of the report, or better, on the map and any sections that are submitted with the report 2. General information Each report should include definite statements concerning the following matters: A. Location and size of the subject area and its general setting with respect to major geographic and geologic features B. Who did the geologic mapping upon which the report is based and when was the mapping done C. Any other kinds of investigations made by the geologist and where pertinent, reasons for doing such work D. Topography and drainage in the subject area E. Abundance, distribution and general nature of exposures of earth materials within the area F. Nature and source of available subsurface information. Suitable explanations should provide any technical reviewer with the means for assessing the probable reliability of such data. (Subsurface relationships can be variously determined or inferred, for example, by projection of surface features from adjacent areas, by the use of test hole logs, and by interpretation of geophysical data, and it is evident that different sources of such interpretation can differ markedly from one another in degree of detail and reliability according to the method used.) 3. Geologic Descriptions The report should contain brief but complete descriptions of all natural materials and structural features recognized or inferred within the subject area. Where interpretations are added to the recording of direct observations, the basis for such interpretations should be clearly stated. The following checklist may be useful as a general, though not necessarily complete, guide for descriptions: A. Bedrock (igneous, sedimentary, metamorphic types):

1) Identification as to rock type (e.g., granite, silty sandstone, etc.) 2) Relative age, and where possible, correlations with named formations 3) Distribution 4) Dimension features (e.g., thickness, outcrop breadth, vertical extent) 5) Physical characteristics (e.g., color, grain size, nature of stratification, foliation, or schistocity, hardness, coherence) 6) Special physical or chemical features (e.g., calcareous or siliceous cement, concretions, mineral deposits, alteration other than weathering) 7) Distribution and extent of weather zones; significant differences between fresh and weathered rock 8) Response to natural surface and near surface processes (e.g., raveling, gullying) B. Structural features, stratification, foliation, schistocity, folds, zones of contortion or crushing, joints, shear zones, faults, etc. 1) Occurrence and distribution 2) Dimensional characteristics 3) Orientation, and shifts in orientation 4) Relative ages (where pertinent) 5) Specific effects upon the bedrock (Describe conditions of the planar surfaces) 6) Specific features of faults (e.g., zones of gorge and breccia, nature of offsets, timing of movements); are faults active in either the geologic sense or the historical sense C. Surficial (unconsolidated) deposits: artificial (man-made) fill, topsoil, stream-laid alluvium, beach sands and gravels, residual debris, lake and pond sediments, swamp accumulations, dune sands, marine and non-marine terrace deposits, talus accumulations, creep and slope wash materials, various kinds of slump and slide debris, etc. 1) Distribution, occurrence and relative age; relationships with existing topography 2) Identification of material as to general type 3) Dimensional characteristics (e.g., thickness, variation in thickness, shape) 4) Surface expression and correlation with features such as terraces, dunes, undrained depressions, anomalous protuberances. 5) Physical or chemical features (e.g., moisture content, mineral deposits, content of expandable clay mineral, alteration, cracks and fissures, fractures) 6) Physical characteristics (e.g., color, grain size, hardness, compactness, coherence, cementation) 7) Distribution and extent of weathered zones; significant differences between fresh and weathered material 8) Response to natural surface and near-surface processes (e.g., raveling, gullying, mass movement) D. Drainage: surface water and groundwater 1) Distribution/occurrence (e.g., streams, ponds, swamps, springs, seeps, subsurface basins) 2) Relations to topography 3) Relations to geologic features (e.g., previous strata, fractures, faults) 4) Sources and permanence 5) Variations in amounts of water (e.g., intermittent spring and seeps, floods) 6) Evidence for earlier occurrence of water at localities now dry 7) Effect of water on the properties of the in-place materials E. Features of special significance (if not already included in the foregoing descriptions) 1) Features representing accelerated erosion (e.g., cliff reentrants, badlands, advancing gully heads)

4. Mineral Resources 2) Features indicating subsidence or settlement (e.g., fissures, scarplets, offset reference features, historic records and measurements) 3) Features indicating creep (e.g., fissures, scarplets, distinctive patterns of cracks and/or vegetation, topographic budges, displaced or tilted reference features, historic records and measurements) 4) Slump and slide masses in bedrock and/or surficial deposits; distribution, geometric characteristics, correlation with topographic and geologic features, age and rates of movement 5) Deposits related to recent floods (e.g., talus aprons, debris ridges, canyon-bottom trash) 6) Active faults and their recent effects upon topography and drainage The types, location and value of mineral resources within the land to be subdivided. These include, but are not limited to, limestone used for construction, coal, sand, gravel, and quarry aggregate, for which extraction by an extractor is or will be commercially feasible, or which is a deposit having significant economic or strategic value to the county, state or nation. Any area known to contain a commercial mineral deposit shall not be subdivided until such deposit is extracted, unless the Board of County Commissioners finds that extraordinary environmental damage or public hazard results from such extraction. 5. The Bearing of Geologic Factors upon the Intended Land Use Treatment of this general topic, whether presented as a separate section or integrated in some manner with the geologic descriptions, normally constitutes the principle contribution of the report. It involves both the effects of geologic features upon the proposed grading, construction, and land use; and the effects of these proposed modifications upon future geological processes in the area. The following checklist includes the topics that ordinarily should be considered in submitting discussion, conclusions, and recommendations in the geologic reports: A. General compatibility of natural features with proposed land use: Is it basically reasonable to develop the subject area? 1) Topography 2) Lateral stability of earth materials 3) Problems of flood inundation, erosion, and deposition 4) Problems caused by features or conditions in adjacent properties 5) Other general problems B. Special recommendations 1) Areas to be left as natural ground 2) Removal or buttressing of existing slide masses 3) Flood protection 4) Problems of groundwater circulation 5) Position of structures, with respect to active faults PERFORMANCE REPORT GUIDELINES (Individual Sewage Disposal Systems (ISDS), if applicable) 1. For lots between one acre to five acres where individual sewer systems are proposed, a report conforming to the following standards shall be submitted in addition to the Performance Report Guidelines for Geology and Soils Report. The report shall be prepared by a registered professional engineer licensed to practice in Colorado. A map drawn at the same scale as the preliminary plan locating all lots, drainage-ways, flood plains, slopes in excess of thirty percent, surface and subsurface soils hazards, geologic hazards, depth to bedrock, water table depth and other hazards.

2. The report shall address the following: A. Percolation tests shall be conducted for no fewer that twenty percent of the total number of lots in the filing. In cases in which unique geologic, topographic, or soils conditions, such as: depth to bedrock, depth to water. Slopes in excess of ten percent, etc. are found, additional tests may be required by the appropriate review agency. B. All locations not suited for placement of leach fields due to soils, geologic, topographic, or hazard conditions shall be noted on the plan. The Change of Zone plan shall be designed as to insure that each lot has a minimum of two sites appropriate for individual sewage disposal systems (ISDS) which do not fall in the restricted zones noted on the plan. C. Relationship of the leach fields to leach fields, wells, and structures, lakes, streams, irrigation systems, and other water forms on adjoining parcels and identification of any possible hazards. Such identification shall be based on an analysis of the probable effects of water on the soils, geology and hydrology of the area. D. The availability of a central sewage system and the feasibility of inclusion into such systems. In the event a community sewer system collection line is constructed within four hundred feet of the PUD, the lot shall abandon their septic system and obtain service from that community system. All Sketch Plan applications will be submitted to the Colorado Geological Survey for review along with the required geologic maps and investigation reports. The following fee shall be collected by the Department of Planning Services at the time the Sketch Plan is submitted. As the fee will be forwarded, please make checks payable to the Colorado Geological Survey. Colorado Geological Survey Application Fees: All Sketch Plan applications will be submitted to the Colorado Geological Survey for review along with the required geologic maps and investigation reports. The following fee shall be collected by the Department of Planning Services at the time the Sketch Plan is submitted. As the fee will be forwarded, please make checks payable to the Colorado Geological Survey. Very Small Residential Subdivisions: 1-3 dwellings and <100 acres. Cost = $600.00 Small Subdivision Review: Subdivisions with >3 dwellings and <100 acres. Cost = $950.00 Large Subdivision Reviews: Subdivisions with >100 acres and <500 acres. Cost = $1550.00 Very Large Subdivision Review: Five hundred acres or more. Cost =$2500.00 For more information, please contact the Colorado Geological Survey Division of Minerals and Geology, 1313 Sherman St, Rm 715, Denver CO 80203 (303) 866-2611.

MINOR SUBDIVISION SKETCH PLAN APPLICATION FOR PLANNING DEPARTMENT USE RECEIPT/AMOUNT # _/$ APPLICATION RECEIVED BY DATE RECEIVED: _ CASE # ASSIGNED: PLANNER ASSIGNED: Parcel Number - - - - (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) (Include all lots being included in the application area. If additional space is required, attach an additional sheet) Legal Description, Section, Township North, Range West Property Address (If Applicable) Existing Zone District: Proposed Zone District: Total Acreage: Proposed #/Lots_ Average Lot Size:_Minimum Lot Size: _Proposed Subdivision Name: FEE OWNER(S) OF THE PROPERTY (If additional space is required, attach an additional sheet) Name: Work Phone #Home Phone #Email Address Address: City/State/Zip Code APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany applications signed by Authorized Agent) Name: Work Phone #Home Phone #Email Address Address: City/State/Zip Code UTILITIES: Water: Sewer: Gas: Electric: Phone: DISTRICTS: School: Fire: Post Office: I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. Signature: Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date

MINOR SUBDIVISION CHANGE OF ZONE SUBMITTAL CHECKLIST The Minor Subdivision Change of Zone is the second step of the three step Minor Subdivision application process. In order to proceed with the Change of Zone application, the applicant must have completed the Minor Subdivision Sketch Plan procedure. The applicant shall schedule an appointment with the planner of record who processed the Sketch Plan application to submit the Change of Zone application. The Department of Planning Services may request additional information, application packets and/or fees that will aid in the review of the Change of Zone application. APPLICATION REQUIREMENTS: Unless otherwise indicated in the Sketch Plan comments, the applicant shall submit the Minor Subdivision Change of Zone application fee and the required Change of Zone application materials as follows: Change of Zone application One digital or electronic copy of completed application materials, if required Minor Subdivision Change of Zone plat (plat shall conform to Section 23-2-50.D of the Weld County Code) Vicinity and Land Use map (map shall conform to Section 23-2-50.C of the Weld County Code) An electronic copy of plat Minor Subdivision Change of Zone questionnaire. Questionnaire shall address items identified in Section 23-2-50.E. 3, 4, 5, 6, 8, 9, 10, 11 of the Weld County Code. Mineral resource statement prepared by a certified geologist or other qualified expert (if required at the Sketch Plan) Document showing evidence of adequate water supply (e.g. well permit or letter from water district), that has been approved by the Weld County Attorney s office. If using a well, please complete the attached Water Supply Information Summary. Legible deed or legal instrument identifying applicant's interest in the property. If an authorized agent signs the application for the fee owner, a power of attorney to the agent from the property owner shall be provided. Soils report (soils report available at Soil Conservation Service Office) Affidavit and certified list of the names and addresses of surface owners within 500 feet of property (form attached). The source of such list shall be assembled from the records of the Clerk and Recorder, title or abstract company, an attorney or the Weld County Website, www.co.weld.co.us. The affidavit and certified list shall be completed within thirty days of the application submission date. Statement from the Weld County Treasurer showing no delinquent taxes exist for the original parcel Agreement with the owner of any ditch located on the site or adjacent to the site in accordance with Section 23-2- 50.B.14 of the Weld County Code Application fee Drainage Report Traffic Study Flood Hazard Development Permit (FHDP) Geologic Hazard Development Permit (GHDP) The applicant shall submit 1 packet containing one original of all of the above for a 7 day completeness review. The packet shall be bound with either paper clips or binder clips (no substitutes). Applications bound in any other fashion may be returned to the applicant without review.

MINOR SUBDIVISION CHANGE OF ZONE APPLICATION FOR PLANNING DEPARTMENT USE RECEIPT # /AMOUNT # _/$ APPLICATION RECEIVED BY DATE RECEIVED: _ CASE # ASSIGNED: PLANNER ASSIGNED: Parcel Number - - - - (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) (Include all lots being included in the application area. If additional space is required, attach an additional sheet) Legal Description, Section, Township North, Range West Property Address (If Applicable) _ Existing Zone District: Proposed Zone District: Total Acreage: Proposed #/Lots Average Lot Size: _Minimum Lot Size: _ Proposed Subdivision Name: FEE OWNER(S) OF THE PROPERTY (If additional space is required, attach an additional sheet) Name: Work Phone # Home Phone # Email Address_ Address: City/State/Zip Code: _ APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany applications signed by Authorized Agent) Name: Work Phone # Home Phone # Email Address_ Address: City/State/Zip Code UTILITIES: Water: Sewer: Gas: Electric: Phone: DISTRICTS: School: Fire: Post Office: I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. Signature: Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date

MINOR SUBDIVISION FINAL PLAT SUBMITTAL CHECKLIST In order to proceed with the Minor Subdivision Final Plat application, the applicant must have completed both the Minor Subdivision Sketch Plan and Minor Subdivision Change of Zone procedures. The Department of Planning Services may request additional information, application packets and/or fees that will aid in the review of the Final Plat application. APPLICATION REQUIREMENTS: Unless otherwise indicated in the Sketch Plan comments, the applicant shall submit the Minor Subdivision Final Plat application fee and the required Final Plat application materials as follows: Title commitment issued by a title insurance company or a title opinion by an attorney licensed to practice in the State of Colorado. The commitment or opinion shall set forth the names of all owners of property. The commitment or opinion shall include a list of all mortgages, judgments, liens, easements, contracts, and agreements of record in Weld County affecting the property described in the application. If the attorney's opinion or title commitment discloses additional holders or owners of such mortgages, judgments, liens, easements, contracts, or agreements, not party to the application, the Board may require them to join in and approve it. The title commitment or opinion shall be completed with thirty days prior to the application submission date. Minor Subdivision Narrative. Narrative shall address Section 24-3-50; items C through G and Section 24-3-60.I; items one through sixteen of the Weld County Code. One digital or electronic copy of completed application materials, if required Letter of intent from the appropriate public agency stating it will accept the lands to be dedicated if the applicant is to dedicate land for schools, roads, parks, or other public purposes. Water supply report in accordance with Section 24-3-50.I. If water is to be supplied by a water district, municipality, or other agency, a copy of a contract, or some tangible guarantee, shall be submitted. Description of the proposed sewage disposal system in accordance with Section 24-3-50.J. If public sewage treatment is proposed a copy of a contract or other tangible guarantee providing for adequate sewage treatment by a public sewage treatment agency shall be submitted. Letter from energy and utility suppliers indicating availability of services. Any covenants, grants of easement, and restrictions imposed upon any land, buildings, and structures within the proposed minor subdivision. Colorado Department of Transportation access permit if a road or street within the proposed minor subdivision intersects with a State Highway. If applicable, copy of an agreement signed by the applicant and representative of the irrigation ditch company. The agreement shall specify the maintenance of the ditch. Proof of an existing easement or dedicated right-of-way when it is contiguous to an easement or rightof-way of the proposed minor subdivision. Proposed subdivision on-site private improvements agreement in accordance with the Weld County Policy on Collateral for Improvements. If applicable, a proposed off-site public road improvements agreement. The agreement shall be made in accordance with Section 24-9-20 of the Weld County Code. Drainage report that is in compliance with the requirements of Section 24-7-120 and 24-7-130 of the Weld County Code.

One copy of affidavit and certified list of the names, addresses and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of property (the surface estate) within 500 feet of property being considered. This list shall be compiled from the records of the Weld County Assessor, the Weld County Website, www.co.weld.co.us, or a person qualified to do the task, and shall be current as of a date no more than thirty days prior to the date the application is submitted to the Department of Planning Services. Final plat map in accordance with Section 24-3-50.U of the Weld County Code. Erosion control plan, if required at the sketch plan Road plans. A complete estimate of costs shall accompany the road plans. Statement from the Weld County Treasurer showing no delinquent taxes exist for the original parcel. Title commitment or a title opinion covering all public dedications Legible warranty deed, if required, which deeds to the proper entity any lands to be used for the benefit of the public or owners and future owners of the minor subdivision. Electronic copy of all plats Application fee Investigation fee, if required (see front page) Drainage Report Traffic Study Flood Hazard Development Permit (FHDP) Geologic Hazard Development Permit (GHDP) The applicant shall submit 1 packet containing one original of all of the above for a 7 day completeness review. The packet shall be bound with either paper clips or binder clips (no substitutes). Applications bound in any other fashion may be returned to the applicant without review.

MINOR SUBDIVISION FINAL PLAN APPLICATION FOR PLANNING DEPARTMENT USE RECEIPT # /AMOUNT # _/$ APPLICATION RECEIVED BY DATE RECEIVED: _ CASE # ASSIGNED: PLANNER ASSIGNED: Parcel Number - - - - (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) (Include all lots being included in the application area. If additional space is required, attach an additional sheet) Legal Description, Section, Township North, Range West Property Address (If Applicable) _ Existing Zone District: Proposed Zone District: Total Acreage: Proposed #/Lots Average Lot Size: _Minimum Lot Size: _ Proposed Subdivision Name: FEE OWNER(S) OF THE PROPERTY (If additional space is required, attach an additional sheet) Name: Work Phone # Home Phone # Email Address Address: City/State/Zip Code APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany applications signed by Authorized Agent) Name: Work Phone # Home Phone # Email Address Address: City/State/Zip Code UTILITIES: Water: Sewer: Gas: Electric: Phone: DISTRICTS: School: Fire: Post Office: I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. Signature: Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date

AFFIDAVIT OF INTEREST OWNERS SURFACE ESTATE Property Legal Description: Parcel Number - - - - (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) (Include all lots being included in the application area. If additional space is required, attach an additional sheet) THE UNDERSIGNED, being first duly sworn, states that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of property (the surface estate) within five hundred feet of the property being considered. This list was compiled from the records of the Weld County Assessor, or a person qualified to do the task, and shall be current as of a date no more than thirty days prior to the date the application is submitted to the Department of Planning Services. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. I (We) hereby depose and state under the penalties of perjury that all statements, proposals and/or plans submitted with or contained within the application are true and correct to the best of my (our) knowledge. Signature Date Signature Date Signature Date

CONTACT INFORMATION AND OFFICE LOCATIONS Weld County Planning and Zoning Weld County Department of Public Works Planning Access Permits Floodplain Administration Engineering 1555 N. 17 th Avenue 1111 H Street Greeley CO 80631 Greeley CO 80631 (970) 400-6100 (970) 400-3750 www.weldgov.com/departments/public_works www.weldgov.com/departments/planning_and_zoning Colorado Dept. of Transportation 10601 W. 10 th Street Weld County Building Inspection Greeley CO 80634 Building Permits (970) 353-1232 Department of Planning 1555 N. 17 th Avenue www.codot.gov Greeley CO 80631 (970) 400-6100 Weld County Department of Public Health and Environment www.weldgov.com/departments/building Weld County Septic Permits On Site Waste Water Systems (OWTS) Division of Water Resources 1555 N 17 th Ave Water Wells Greeley CO 80631 1313 Sherman St (970) 304-6415 Room 818 Denver CO 80203 www.weldgov.com/departments/health_and_environment (303) 866-3581 Soil Conservation Districts 810 Ninth St Big Thompson (Fort Collins) - 970-493-1638 Second Floor Boulder Valley (Longmont) - 303-776-4034 Greeley CO 80631 Centennial - 970-522-7440 x3 (970) 352-8712 Fort Collins - 970-221-0611 Morgan - 970-867-9659 x3 www.water.state.co.us Platte Valley (Brighton) - 303-857-6721 Southeast Weld (Brighton) - 303-659-7004 x101 Well permitting information: West Adams (Brighton) - 303-659-2080 West Greeley - 970-356-8097 x3 www.dwr.state.co.us/wellpermitsearch/default.aspx www.coloradoacd.org Colorado Geological Survey Division of Minerals and Geology Colorado Department of Public Health and 1313 Sherman Street Environment Room 715 4300 Cherry Creek Drive South Denver CO 80203 Denver CO 80246 (303) 384-2643 (303) 692-2000 www.coloradogeologicalsurvey.org www.colorado.gov/cdphe

DRAINAGE REPORT REVIEW CHECKLIST Project Name: The purpose of this checklist is to provide the applicant s Engineer a basic list of items that County Staff will review in regards to a drainage report. The drainage design shall meet the requirements of the Weld County Code and commonly accepted engineering practices and methodologies. A detention pond design (or other stormwater mitigation design) is appropriate for projects which have a potential to adversely affect downstream neighbors and public rights-of-way from changes in stormwater runoff as a result of the development project. The design engineer s role is to ensure adjacent property owners are not adversely affected by stormwater runoff created by development of the applicant s property. REPORT ( = complete, = required) Stamped by PE, scanned electronic PDF acceptable Certification of Compliance Variance request, if applicable Description/Scope of Work Number of acres for the site Methodologies used for drainage report & analysis Design Parameters Design storm Release rate URBANIZING or NON-URBANIZING Overall post construction site imperviousness Soils types Discuss how the offsite drainage is being routed Conclusion statement must also include the following: Indicate that the historical flow patterns and run-off amounts will be maintained in such a manner that it will reasonably preserve the natural character of the area and prevent property damage of the type generally attributed to run-off rate and velocity increases, diversions, concentration and/or unplanned ponding of storm run-off for the 100-year storm. How the project impacts are mitigated. Construction Drawings Drawings stamped by PE, (scanned electronic PDF preferred) Drainage facilities Outlet details Spillway Maintenance Plan Frequency of onsite inspections Repairs, if needed Cleaning of sediment and debris from drainage facilities Vegetation maintenance Include manufacturer maintenance specifications, if applicable Comments: 4/27/2016 Weld County Colorado Department of Public Works Development Review 1111 H Street, Greeley, CO 80631 Ph: 970-400-3750 Fax: 970-304-6497 www.weldgov.com/departments/public_works/development_review