NOTICE OF APPEAL

INSTRUCTIONS

Print or type clearly. Use additional sheets if necessary. All required attachments shall be submitted with this form. Incomplete or inaccurate information may delay public hearing or decision dates. This form may be used by any person who is adversely affected by a decision regarding the approval or disapproval of a subdivision within the County's jurisdiction, and shall be in compliance with the requirements of the County Subdivision Regulations. This form must be accompanied by the required administrative fee.

APPELLANT INFORMATION

1. Name ___________________________________________________________________________
    Address________________________________________________________________
    Phone Number ___________________________________
   Signature ______________________________________   Date ____________________ 

2. Agent (if any) Name _____________________________________________________________
      Address ______________________________________________________________________
      Phone Number ___________________________________
      Signature _______________________________________  Date _____________________  

NATURE OF APPEAL

3. Reason for Appeal (reference to specific decision being appealed) ___________________________
_______________________________________________________________________________
_______________________________________________________________________________

4. Ruling Authority for this appeal Attach a copy of the decision or order being appealed.

PROCEDURAL INFORMATION (To be completed by County Staff)

5. Date of action being appealed _____________________

6. Date Notice of Appeal received by County __________________ Signed _______________________

 7. Date of decision regarding appeal by Board of County Commissioners __________________________

EXECUTED DOCUMENTS RECORDED BY COUNTY CLERK'S OFFICE

1. Disclosure Statement

2. Restrictive Covenants

3. Schedule of Compliance

4. Phased Development Plan

5. State Engineer's Opinion

6. Engineer's Road Plans

7. Engineer's Completion Affidavit

8. Environmental Improvement Division Opinion

9. Soil and Water Conservation District Opinion

10. State Highway Department Opinion

11. Performance Bond

12. Letter of Credit

13. Other Collateral (describe)_________________________________________

14. Financial Statement

15. Statement of availability and estimated cost to serve customers by following utility services:
A. Electric
B. Gas
C. Telephone
D. Water
E. Liquid Waste Disp.
F. Solid Waste Disp.

16. Contracts Conveying Interest (sale or lease)

17. Advertising Materials