USE BY SPECIAL REVIEW (USR)
PROCEDURAL GUIDE CHECKLIST
DEPARTMENT OF PLANNING SERVICES * 1555 N. 17TH AVENUE * GREELEY, CO 80631
www.weldgov.com 970-353-6100 EXT 3540 * FAX 970-304-6498
APPLICATION REQUIREMENTS
The applicant shall submit 1-hard copy and 1-electronic copy containing one of all of the items listed.
The application will be reviewed for completeness during the Completeness Review.
_____
Submit a copy of the Pre-application meeting minutes.
_____
Submit application form (see attached).
_____
Submit Applicant’s representative/authorization form if applicant or authorized agent is
different than owner. Submit incorporation documents if the owner is an LLC, INC, etc.
_____
Submit responses to USR questionnaire. See attached.
_____
Submit USR map with paper dimensions of 24" X 36". See attached for map requirements.
_____
Submit Certificate of Conveyances form and all attachments. Contact a title company to
obtain a Certificate of Conveyances. The Certificate of Conveyances expires in thirty days
of the signing date on the cover sheet.
_____
Submit a list of all the surrounding property owners (surface estate) within 500 feet of the
property under consideration. This list must be a certified list of the names, addresses, and
the corresponding parcel number assigned by the Weld County Assessor of the owners’ of
property. Also submit the affidavit stating that the list is accurate. This list shall be compiled
from the records of the Weld County Assessor, the Weld County Website, www.co.weld.us,
or a person qualified to do the task. This list expires in thirty days of the date compiled.
_____
Submit copy of document showing evidence of adequate water supply (e.g. well permit or
letter from water district). If using a well, please complete the attached Water Supply
Information Summary.
_____
Submit copy of document showing evidence of adequate sewage disposal (e.g. septic permit
or letter from the sanitary sewer district)
_____
Submit Weld County Access Permit Application Form, if required. Clearly indicate all
existing and proposed accesses (residential, agricultural, oil and gas, ditch, etc). Include
photos looking into, left and right for each existing or proposed access. Applications will not
be processed without photos.
_____
Notice of Inquiry or letter/email from a municipality if the site is located within an
Intergovernmental Agreement (IGA) boundary or a Cooperative Planning Area (CPA).
_____
Detention design summarized in a Drainage Report if required per pre-application meeting
minutes.
_____
Traffic Study if required per pre-application meeting minutes.
_____
If violation case hold a community meeting for owners within 500 feet of property boundary
and submit meeting minutes.
_____
Submit all required documents on a CD or via email in .pdf format.
_____
Application fee
_____
Investigation fee, due only if this is a violation.
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USE BY SPECIAL REVIEW (USR) PROCEDURAL GUIDE
HEARINGS/MEETI NGS
NUMBER OF DAYS AFTER SUBMITTAL OF
COMPLETE APPLICATION
Prior to Planning Commission Meeting
~80 days
Planning Commission Public Hearing
~90 days
Board of County Commissioners Public Hearing
~3-5 weeks after the Planning Commission Hearing
USR TYPE
FEE








Single family dwelling units (other than those permitted under Section 23-3-20.A)
Expansion of a non-conforming use
Home business
Animal boarding as permitted in Section 23-3-50.D.
Bed and breakfast facility
Oil and Gas storage facilities
Mobile home for caretakers
Accessory buildings with a gross floor area larger than set forth in Section 23-3-40.Q.
$ 1,200.00

Composting Facilities
$ 2,415.00

Confined Animal Feeding Operations
Less than or equal to 1,000 animal units**
Up to and including each additional 1,000 animal units**
$ 2,415.00
$ 500.00
** Animal Units as defined in Section 23-1-90 of the Weld County Code

Non-1041 Major Facility of a Utility
$ 5,000.00

1041 Facilities as defined in Chapter 21 of the Weld County Code
$ 10,000.00

All other Use by Special Review Permits
$ 2,500.00
Recording fee: $13.00 for the first page and $10.00 for each additional page to record the final Mylar.
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.
A copy of the Weld County Code is available online at www.co.weld.co.us (Quick Link>County Code)
PURPOSE
The purpose of this packet is to provide information to the applicant regarding Weld County’s Site Specific
Development Plan and Use by Special Review Permit process.
INTENT AND APPLICABILITY
The purpose of this packet is to provide general information to an applicant about the Use by Special Review
application process. It is not intended to be a substitute for the specific requirements of Weld County Code, Chapter
23, Article II, Division 4. It is the responsibility of the applicant to be knowledgeable of the specific requirements of
the Weld County Code, Chapter 23, Article II, Division 4, for the Use by Special Review application process.
Uses by Special Review are uses which have been determined to be more intense or to have a potentially greater
Impact that the Uses Allowed by Right in a particular zone district. Therefore, Uses by Special Review require
additional consideration to ensure that they are established and operated in a manner that is compatible with
existing and planned land uses in the neighborhood. The additional consideration of Uses by Special Review is
USE
B Y S PECIA L
REV IEW
( USR)
PROCEDU RA L
GUIDE
designed to protect and promote the health, safety, convenience, and general welfare of the present and future
residents of Weld County.
The Department of Planning Services is responsible for reviewing and processing the application in accordance
with Section 23-2-210 of the Weld County Code. The Planning Commission will consider the application in
accordance with Section 23-2-220 of the Weld County Code. The Planning Commission will provide a
recommendation to the Board of County Commissioners concerning the application. The Board of County
Commissioners will consider the application in accordance with Section 23-2-230 of the Weld County Code.
It is recommended that the applicant attend all hearings scheduled for consideration of the application in order to
present the proposal and answer any questions. The applicant is also encouraged to communicate with the Planner
assigned to process and review the application once it has been submitted in order to keep up to date with any
developments pertaining to the application.
PRE-APPLICATION REVIEW REQUEST MEETING
Any person wanting to apply for a USR shall arrange for a pre-application conference with the Department of
Planning Services.
APPLICATION REQUIREMENTS:
It is the responsibility of the applicant to meet the application requirements outlined in Section 23-2-260 of the Weld
County Code. No Use by Special Review application shall be assigned a case number to be reviewed until all
required items on the Use by Special Review submittal checklist have been completed and submitted to the
Department of Planning Services.
A Use by Special Review permit map shall be submitted and delineated on reproducible Mylar materials approved
by the Department of Planning Services. The dimensions of the map shall be 36 inches by 24 inches. The Use by
Special Review Permit Map shall include certificates for the property owner's signature, the Planning Commission,
and the Board of County Commissioners. The map shall contain a vicinity map and plot plan as described in
Section 23-2-260.B., of the Weld County Code. Please refer to the attached Use by Special Review Permit Map
Checklist for additional information.
An applicant for a Use by Special Review permit shall demonstrate compliance with the Design Standards outlined
in Section 23-2-240 and with the Operation Standards outlined in Section 23-2-250 of the Weld County Code.
SIGN POSTING
The Department of Planning Services will be responsible for posting a sign on the property under consideration in a
location readily visible from the adjacent roadway(s). The sign will be posted at least ten days preceding the
hearing date, both for the Planning Commission hearing and again for the Board of County Commissioners'
hearing. The sign will be provided by the Department of Planning Services. The sign will be posted adjacent to and
visible from a publicly maintained road right-of-way. In the event the property under consideration is not adjacent to
a publicly maintained road right-of-way, second sign at the point at which the driveway (access drive) intersects a
publicly maintained road right-of-way will be posted. The sign posting will be evidenced with a photograph.
VESTED PROPERTY RIGHT
A form of vested property right will be established for a three year period upon the effective date of the Board of
County Commissioners' final or conditional approval of a Use by Special Review permit. The vested right runs with
the property and gives the landowner the right to undertake and complete development of the Use by Special
Review permit. Weld County may attach terms and conditions to the Use by Special Review permits as may be
reasonably necessary to protect the public health, safety, and welfare. Failure by the landowner to abide by any of
the terms and conditions will result in a forfeiture of the vested property right. Approval of a vested property right
shall not constitute an exemption from or waiver of any provisions of Weld County's regulations pertaining to the
development and use of property.
INVESTIGATION FEE
An additional fifty percent of the permit fee shall be added to the cost of the Use by Special Review permit
application fee when the use is started without a Use by Special Review permit. The payment of the investigation
fee shall not relieve any persons from fully complying with the requirements of the Weld County Code, Chapter 23,
nor from any other penalties.
*********
USE
B Y S PECIA L
REV IEW
( USR)
PROCEDU RA L
GUIDE
APPROVAL PROCESS
Pre Application Meeting
(No Fee)
Application Submitted
(No Fee)
7-Day Completeness Review by Staff
Complete Submittal
Incomplete Submittal
Applicant submits additional
application materials
Application Fee submitted
Application Materials sent to referral agencies for comment (28 days)
Planner sends the referral agency comments to the applicant and
discusses the referral agency comments with the applicant (between 30-45 days)
Applicant sends letters to the mineral owners per C.R.S. 24-65.5-103
(30 days prior to the Planning Commission Public Hearing)
Planning Commission Public Hearing
(surrounding property owners notified of the project and the hearing date)
Board of County Commissioners’ Public Hearing
(surrounding property owners notified of the project and the hearing date)
Applicant addresses all the conditions of approval and
submits either a paper copy of the plat or a .pdf and an
Improvements Agreement (if applicable)
Staff reviews plat and conditions for completeness
Plat and
conditions
incomplete
Plat and
conditions
complete
Mylar and recording fee submitted
Mylar recorded
CONTACT INFORMATION AND OFFICE LOCATIONS
Weld County Planning and Zoning
Planning
Engineering
Floodplain Administration
th
1555 N. 17 Avenue
Greeley CO 80631
(970) 353-6100, Ext. 3540
Weld County Department of Public Works
Access Permits
1111 H Street
Greeley CO 80631
(970) 356-4000 x3750
www.weldgov.com/Departments/PlanningZoning
Colorado Dept. of Transportation
1420 Second St reet
Greeley CO 80631
(970) 353-1232
Weld County Building Inspection
Building Permits
Department of Planning
th
1555 N. 17 Avenue
Greeley CO 80631
(970) 353-6100 x3540
www.weldgov.com/Departments/PlanningZoning
Division of Water Resources
Water Wells
1313 Sherman St
Room 818
Denver CO 80203
(303) 866-3581
810 Ninth St
Second Floor
Greeley CO 80631
(970) 352-8712
www.water.state.co.us
Well permitting information:
www.weldgov.com/Departments/PublicWorks
www.coloradodot.info
Weld County Department of Public Health and
Environment
Weld County Septic Permits
On Site Waste Water Systems (OWTS)
th
1555 N 17 Ave
Greeley CO 80631
(970) 304-6415
www.weldgov.com/Departments/HealthEnvironment
Soil Conservation Districts
Big Thompson (Fort Collins) - 970-493-1638
Boulder Valley (Longmont) - 303-776-4034
Centennial - 970-522-7440 x3
Fort Collins - 970-221-0611
Morgan - 970-867-9659 x3
Platte Valley (Brighton) - 303-857-6721
Southeast Weld (Brighton) - 303-659-7004 x101
West Adams (Brighton) - 303-659-2080
West Greeley - 970-356-8097 x3
www.dwr.state.co.us/WellPermitSearch/default.aspx
www.cacd.us
Colorado Geological Survey
Division of Minerals and Geology
1313 Sherman Street
Room 715
Denver CO 80203
(303) 866-2611
www.coloradogeologicalsurvey.org
DEPARTMENT OF PLANNING SERVICES
1555 N 17th AVE
GREELEY, CO 80631
PHONE: (970) 353-6100, Ext. 3540
FAX: (970) 304-6498
AUTHORIZATION FORM
I_______________________________represent__________________________for the property
(Agent/Applicant)
(Owner)
located at_____________________________________________________________________.
LEGAL DESCRIPTION:
SEC________TWN________RNG________
SUBDIVISION NAME: __________________________________LOT______BLK_____
I can be contacted at the following phone #'s:
Home
Work
Email: _______________________________________
Fax #
The property owner can be contacted at the following phone #'s
Home
Work
Email: _______________________________________
Fax #
Correspondence
mailedemailed
to (onlyto:
one):
Correspondence
(Check one)
Agent/Applicant
Property Owner
DATE___________________
OWNER'S SIGNATURE________________________________________________
USE BY SPECIAL REVIEW (USR) APPLICATION
DEPARTMENT OF PLANNING SERVICES * 1555 N. 17TH AVENUE * GREELEY, CO 80631
www.weldgov.com * 970-353-6100 EXT 3540 * FAX 970-304-6498
FOR PLANNING DEPARTMENT USE:
AMOUNT $
APPLICATION RECEIVED BY
DATE RECEIVED:
CASE # ASSIGNED:
PLANNER ASSIGNED:
Parcel Number*: ___ ___ ___ ___ - ___ ___ - ___ - ___ ___ - ___ ___ ___
Address of site:
Legal Description:
Zone District:
Section:
Acreage:
Floodplain: Y N
(*A 12 digit number on Tax I.D.
information, obtainable at
w w w .w eldgov.com).
Township:
Geological Hazard: Y N
N
Range:
W
Airport Overlay: Y N
FEE OWNER(S) OF THE PROPERTY:
Name:
Company:
Phone #:
Street Address:
City/State/Zip Code:
Email:
Name:
Company:
Phone #:
Street Address:
City/State/Zip Code:
Email:
Name:
Company:
Phone #:
Street Address:
City/State/Zip Code:
Email:
APPLICANT OR AUTHORIZED AGENT: (See below: Authorization must accompany all applications signed by Authorized Agents)
Name:
Company:
Phone #:
Street Address:
City/State/Zip Code:
Email:
PROPOSED USE:
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 that the signatory has to legal
authority to sign for the corporation.
Signature: Owner or Authorized Agent
Print Name
Date
Signature: Owner or Authorized Agent
Print Name
Date
Rev 4/2016
USE BY SPECIAL REVIEW (USR) QUESTIONNAIRE
Answer the following questions on a separate sheet. If a question does not pertain to your use, please respond
with “not applicable”. For assistance with some of these questions see this website:
http://www.co.weld.co.us/Departments/PlanningZoning/LandUseA pplicationsAssistance/ApplicationAssistance.html
Planning Questions: Planner on Call 970-353-6100 x3540
1. Explain, in detail, the proposed use of the property.
2. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 22 of the
Comprehensive Plan.
3. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 23 (Zoning) and the
zone district in which it is located.
4. Describe what type of land uses surround the site. Explain how the proposed use is consistent and
compatible with surrounding land uses.
5. What are the hours and days of operation? (e.g. Monday thru Friday 8:00 a.m. to 5:00 p.m.)
6. List the number of full time and/or part time employees proposed to work at this site.
7. If shift work is proposed include the number of employees per shift.
8. List the number of people who will use this site. Include contractors, truck drivers, customers, volunteers, etc.
9. If this is a dairy, livestock confinement operation, kennel, etc., list the number and type of animals.
10. Describe the type of lot surface and the square footage of each type. (e.g. asphalt, gravel, landscaping, dirt,
grass, buildings)
11. How many parking spaces are proposed? How many handicapped (ADA) parking spaces are proposed?
12. Explain the existing and proposed landscaping for the site.
13. Describe the type of fence proposed for the site (e.g. 6 foot chain link with earth tone slats)
14. Describe the proposed screening for all parking and outdoor storage areas.
If the site is located in a floodplain outdoor storage is restricted.
15. Explain any proposed reclamation procedures when termination of the Use by Special Review activity occurs.
16. Who will provide fire protection to the site?
17. List all proposed on-site and off-site improvements associated with the use (e.g. landscaping, fencing,
buildings, drainage, turn lanes, etc.) and a timeline of when you will have each one of the improvements
completed.
Engineering questions: 970-353-6100 x3540
1. Describe how many roundtrips/day are expected for each vehicle type: Passenger Cars/Pickups, Tandem
Trucks, Semi-Truck/Trailer/RV (Roundtrip = 1 trip in and 1 trip out of site)
2. Describe the expected travel routes for site traffic.
3. Describe the travel distribution along the routes (e.g. 50% of traffic will come from the north, 20% from the
south, 30% from the east, etc.)
4. Describe the time of day that you expect the highest traffic volumes from above.
5. Describe where the access to the site is planned.
6. Drainage Design: Detention pond summarized in a drainage report is required unless the project falls under an
exception to stormwater detention requirements per code section 23-12-30 F.1.
A. Does your site qualify for an exception to stormwater detention? If so, describe in a drainage narrative the
following:
1. Which exception is being applied for and include supporting documentation.
2. Where the water originates if it flows onto the property from an offsite source
3. Where it flows to as it leaves the property
4. The direction of flow across the property
5. If there have been previous drainage problems with the property
B. Does your site require a stormwater detention pond? If so, the following applies:
1. A drainage report summarizing the detention pond design with construction drawings and maintenance
plan shall be completed by a Colorado Licensed Professional Engineer and adhere to the drainage
related sections of the Weld County Code.
2. The drainage report must include a certification of compliance stamped and signed by the PE which
can be found on the engineering website.
3. A general drainage report guidance checklist is available on the engineering website. More complete
checklists are available upon request.
USE BY SPECIAL REVIEW (USR) QUESTIONNAIRE (PAGE 2)
Environmental Health questions: 970-304-6415 x2702
1. What is the drinking water source on the property?
If utilizing a drinking water well include either the well permit or well permit application that was submitted to
the State-Division of Water Resources. If utilizing a public water tap include a letter from the Water District, a
tap or meter number, or a copy of the water bill.
2. What type of sewage disposal system is on the property?
If utilizing an existing septic system provide the septic permit number. If there is no septic permit due to the
age of the existing septic system, apply for a septic permit through the Department of Public Health and
Environment prior to submitting this application. If a new septic system will be installed please state “a new
septic system is proposed”. Only propose portable toilets if the use is consistent with the Department of Public
Health and Environment’s portable toilet policy.
3. If storage or warehousing is proposed, what type of items will be stored?
4. Describe where and how storage and/or stockpile of wastes, chemicals, and/or petroleum will occur on this
site.
5. If there will be fuel storage on site indicate the gallons and the secondary containment. State the number of
tanks and gallons per tank.
6. If there will be washing of vehicles or equipment on site indicate how the wash water will be contained.
7. If there will be floor drains indicate how the fluids will be contained.
8. Indicate if there will be any air emissions. (e.g. painting, oil storage, etc.)
9. Provide a design and operations plan if applicable. (e.g. composting, landfills, etc.)
10. Provide a nuisance management plan if applicable. (e.g. dairies, feedlots, etc.)
11. Additional information may be requested depending on type of land use requested.
Building questions: Jose Gonzalez 970-353-6100
1. List the type, size (square footage), and number of existing and proposed structures. Show and label all
existing and proposed structures on the USR drawing. Label the use of the building and the square footage.
2. Explain how the existing structures will be used for this USR?
3. List the proposed use(s) of each structure.
An MSWord (.docx) version of this questionnaire is available by request.
USE BY SPECIAL REVIEW (USR) MAP REQUIREMENTS
The size of map is required to be 24”x36” (2’x3’).
Please add the items below to the USR map as they apply to your site.
Vicinity Map Requirements:
1.
2.
3.
4.
5.
Area including a one-half mile radius of the property printed to a legible scale
Section, township, and range
Scale and north arrow
Outline of the perimeter of the parcel
The general classifications and distribution of soils over the parcel under consideration (soil classification
names and agricultural capability classifications must be noted in the legend)
6. Locations and names of all roads, irrigation ditches, and water features
7. Any abutting subdivision outlines and names, and the boundaries of any adjacent municipality
Plot Plan Requirements (no survey required, needs to be drawn to scale):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
One inch equals one hundred feet scale (1" = 100') or other scale as appropriate
Outline of the boundaries of the parcel(s)
Adjacent property lines
Public rights-of-way and/or easements within 200 feet of parcel boundary for telephone, gas, electric, water,
sewer lines etc.
Show and label any existing and proposed structures (including above ground storage tanks)
Show and label location of areas of moderate or severe soil limitations
Show and label location of vehicle and/or equipment washing area
Show and label location, amount, size and type of any existing and proposed landscaping, fencing, walls,
berms, or other screening
Show and label location, amount, size and type of any existing and proposed parking areas
Show and label the sign on the USR drawing include the height, face size, and setback
Show and label the location of all existing and proposed lighting, include details of the type of lighting
Show and label location of all hydrographic features including irrigation ditches, streams, rivers, ponds, and
reservoirs
Show and label location of existing road Right-of-Way, future road Right-of-Way, and Easements
Show and label the unmaintained section line Right-of-Way as “CR ___ Right-of-Way is not County
maintained”
Show and label location of drainage related features (e.g. detention pond(s), ditches, etc.) Detention ponds
shall be labeled as “No Build/Storage Area” and include design volume
Show and label the drainage flow arrows showing how the stormwater flows across the property
Show and label the traffic circulation flow arrows showing how the traffic moves around the property
Show and label location of the access(es) and label with access permit number
Show and label the access turning radii. Show 25 feet for passenger vehicles and 60 feet for trucks.
Show and label the approved tracking control
Show and label the location of any floodplain boundaries. Include permit number, floodplain type, map panel
number, and effective date.
Show and label the location of geological hazard
Show and label the location of mineral resource areas
Add any other relevant information about the property as may be reasonably required by the County to meet
the intent and purpose of the Weld County Code, Chapter 23 (Zoning).
Add the USR map Certificate Signature Blocks (see following page):
1) Property Owner(s), 2) Planning Commission, and 3) Board of County Commissioners
USE BY SPECIAL REVIEW (USR) MAP REQUIREMENTS (PAGE 2)
CERTIFICATION BLOCKS TO BE ADDED TO THE USR MAP
PROPERTY OWNER'S CERTIFICATION
The undersigned major property owner(s) do hereby agree to the Site Specific Development Plan and Use by
Special Review Development Standards as described hereon this _____ day of ________________________,
20 ________.
________________________________
Signature
________________________________
Signature
PLANNING COMMISSION CERTIFICATION
This is the certify that the Weld County Planning Commission has certified and does hereby recommend to the
Board of County Commissioners, Weld County Colorado, for its confirmation, approval and adoption this Site
Specific Development Plan and Use by Special Review as shown and described thereon this ______ day of
________________, 20 ________.
__________________________________
Chair, Weld County Planning Commission
BOARD OF COUNTY COMMISSIONERS CERTIFICATION
This is to certify that the Board of County Commissioners, Weld County, Colorado, does hereby confirm and
adopt this Site Specific Development Plan and Use by Special Review and Development Standards as shown
and described hereon this _____ day of ___________________, 20 _______.
__________________________________
Chair, Board of County Commissioners
ATTEST:
Weld County Clerk to the Board
BY: _______________________________________
Deputy Clerk to the Board
Dated: _________________
Development Review Staff are available to assist the applicant’s through this process.
For questions, please visit us or call the Department of Planning Services at (970) 353-6100
CERTIFICATE OF CONVEYANCES
STATE OF COLORADO
COUNTY OF WELD
WELD COUNTY
DEPARTMENT OF PLANNING SERVICES
The ______________________________ TITLE INSURANCE or ABSTRACT COMPANY hereby certifies that it
has made a careful search of its records, and finds the following conveyances affecting the real estate described
herein since August 30, 1972, and the most recent deed recorded prior to August 30, 1972.
LEGAL DESCRIPTION:
CONVEYANCES (if none appear, so state):
Reception No.___________________________________,
Reception No. ___________________________________,
Reception No. ___________________________________,
Reception No. ___________________________________,
Reception No. ___________________________________,
Reception No. ___________________________________,
Reception No. ___________________________________,
Reception No. ___________________________________,
Book ______________________________
Book ______________________________
Book ______________________________
Book ______________________________
Book ______________________________
Book ______________________________
Book ______________________________
Book ______________________________
The certificate is made for the use and benefit of the Department of Planning Services of Weld County, Colorado.
This certificate is not to be constructed as an Abstract of Title nor an opinion of Title, nor a guarantee Title and
the liability of ___________________________________ COMPANY, is hereby limited to the fee paid for this
Certificate.
In Witness Whereof, ___________________________________ COMPANY, has caused this certificate to be
signed by its proper officer this _______ day of ____________________________, 20 ______, at ___________.
Company: ___________________________________
By:
___________________________________
Authorized Signature
FOR COMMERCIAL SITES, PLEASE COMPLETE THE FOLLOWING INFORMATION
BUSINESS EMERGENCY INFORMATION:
Business
Name:__________________________________________________Phone:_____________________________
Address:____________________________________________ City, ST, Zip:____________________________
Business
Owner:_________________________________________________Phone:______________________________
Home Address:______________________________________ City, ST, Zip:_____________________________
List three persons in the order to be called in the event of an emergency:
NAME
TITLE
ADDRESS
PHONE
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Business
Hours:_________________________________________Days:_______________________________________
Type of Alarm:
None
Burglar
Holdup
Fire
Silent
Audible
Name and address of Alarm Company:___________________________________________________________
Location of Safe:_____________________________________________________________________________
*********************************************************************************************************************************
MISCELLANEOUS INFORMATION:
Number of entry/exit doors in this building:___________Location(s):____________________________________
__________________________________________________________________________________________
Is alcohol stored in building?_______Location(s):___________________________________________________
Are drugs stored in building?_______Location(s):___________________________________________________
Are weapons stored in building?_______Location(s):________________________________________________
The following programs are offered as a public service of the Weld County Sheriff’s Office. Please indicate the
programs of interest.
_______Physical Security Check
_______Crime Prevention Presentation
UTILITY SHUT OFF LOCATIONS:
Main Electrical:______________________________________________________________________________
Gas Shut Off:_______________________________________________________________________________
Exterior Water Shutoff:________________________________________________________________________
Interior Water Shutoff:_________________________________________________________________________
Surrounding Property Owner Affidavit
Surrounding Property Owner Affidavit
AFFIDAVIT
OF Owners
INTEREST
OWNERS
Interest
- Surface
Estate
Affidavit ofAffidavit
InterestofOwners
- Surface
Estate
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 (500)
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
-5-
Weld County Public Works Dept.
1111 H Street
P.O. Box 758
Greeley, CO 80632
Phone: (970)304-6496
Fax: (970)304-6497
ACCESS PERMIT
APPLICATION FORM
Applicant
Property Owner (If different than Applicant)
Name _____________________________________
Name _______________________________________
Company __________________________________
Address _____________________________________
Address ___________________________________
City__________________ State ____ Zip __________
City__________________ State ____ Zip ________
Phone ______________________________________
Business Phone _____________________________
Fax ________________________________________
Fax_______________________________________
E-mail_______________________________________
E-mail _____________________________________
Ÿ= Existing Access
ѐ= Proposed Access
Parcel Location & Sketch
The access is on WCR__________
Nearest Intersection: WCR __________ & WCR __________
Distance from Intersection ___________________________
Parcel Number __________________________________
Section/Township/Range__________________________
Is there an existing access to the property? YES NO
Number of Existing Accesses________________________
Road Surface Type & Construction Information
Asphalt ___ Gravel ___ Treated ___ Other __________
Culvert Size & Type _________________________________
Materials used to construct Access____________________
Construction Start Date _________ Finish Date___________
Proposed Use
Ƒ Temporary (Tracking Pad Required)/ $75
Ƒ Small Commercial or Oil & Gas/$75
Ƒ Field (Agriculture Only)/Exempt
Is this access associated with a Planning Process?
Ƒ Single Residential/$75
Ƒ Large Commercial/$150
Ƒ No
Required Attached Documents
- Traffic Control Plan
-Certificate of Insurance
Ƒ USR
Ƒ RE
Ƒ Industrial/$150
Ƒ Subdivision/$150
Ƒ PUD
Ƒ Other__________
- Access Pictures (From the Left, Right, & into the access)
By accepting this permit, the undersigned Applicant, under penalty of perjury, verifies that they have received all pages of the permit
application; they have read and understand all of the permit requirements and provisions set forth on all pages; that they have the
authority to sign for and bind the Applicant, if the Applicant is a corporation or other entity; and that by virtue of their signature the
Applicant is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws
regarding facilities construction.
Signature_______________________________ Printed Name _________________________ Date _________________
Approval or Denial will be issued in minimum of 5 days.
Revised Date 6/29/10
Approved by____________________________
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 Planning Services | Development Review
1555 N. 17th Avenue, Greeley, CO 80631 | Ph: 970-353-6100 | Fax: 970-304-6498
www.co.weld.co.us/Departments/PlanningZoning