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SPECIAL MANAGEMENT AREA USE PERMIT APPLICATION <br /> COUNTY OF FIAWAI`I <br /> PLANNING COMMISSION <br /> (Type or legibly Print the requested information) <br /> APPLICANT(S): JEREMY GRAHAM <br /> X <br /> APPLICANT'S SIGNATURE: /'/ DATE: I`16-7 q <br /> ADDRESS: _16457 CURL D OAK DRIVE, MONUMENT CO 80132 <br /> LIST APPLICANT'S INTEREST (if not owner): REGISTERED AGENT <br /> PHONE: (Bus.)a05-469-6348 (Res.) _ (Email) i14072(u7amail.com <br /> REQUEST: _-APPROVAL OF SINGLE FAMILY RESIDENCE, IN GROUND POOL— <br /> _ WELL. SEPTIC SYSTEM._RELATED DEVELOPEMNT <br /> TAX MAP KEY: 3 1-5-0 59:049 ZONING: AG /A-1 a <br /> SIZE OF PROPERTY /AREA OF REQUESTED USE: .55 ACRE I 20,000 SQ FT <br /> LANDOWNER(S): _CALCAM INVESTMENTS LLC -- <br /> FEE SIMPLE LANDOWNER(S) WRITTEN AUTIlORIZATION <br /> (may be provided by letter with the below statement included): <br /> DATE: <br /> X -- - —=-� -- _ DATE _ <br /> ACIENT: VAL COLTER _--- - <br /> AGENT ADDRf;SS: 13-64609 KAI_APANA KAPOIJO RD, PAHOA HI 96778 <br /> PIjoNF.: (B,as.) 808-769-294-9 (Res.) — (l.maiWal.col'tcr e�yahoo.com_ <br /> Please indicate to whorn original correspondence and copies should tie sent. <br /> ORMINAL: JEREMY GRAHAM CoPil S: VAL COL TE:1: <br /> Planning Dept. <br /> Exhibit <br />