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Home My WebLink Aboutpitkin.boa.92.21 PITRIN COIINTY BOARD OF ADJIIBTMENT DATE /•~o~'I ~7'~ CASE # ~[ C~ "~ APPLICANT Philip J. & Antonia Palmiotto PHONE 945-4878 MAILING ADDRESS 8240 Countv Rd. 115 #5, Glenwood Springs, CO 81601 OWNER Philip J. & Antonia Palmiotto PHONE 945-4878 MAILING ADDRESS 8240 Countv Rd. 115 #5, Glenwo~d Springs, CO 81601 LOCATION OF PROPERTY Lot 21, Block 2, Crystal River Country Estates Any pertinent data must accompany this application, and will be made part of this Case. The Board may return this application if it does not contain all the facts in question. Applicant Signature ~//I `d~LL~ (To be completed by the Zoninq Department) Provisions of the zoning resolution requiring the Zoning Official to forward this application to the Board of Adjustment, and reasons for not granting a building permit: 5-3a Zone District Requesting: •o~a Lot Size t" d ' Front Yard Setback Variance, where ~' is required. ' Rear Yard Setback Variance, where ' is required. ' Side Yard Setback Variance, where ' is required. ' Side Yard Setback Variance, where ' is required. ' Height Variance, where ' is required. Square Feet where a maximum of sq. ft. is allowed. Other: Zoning Official Application filed -~~ ~ / ~ Parcel ID No. oc~O47 / -~~I - ~~- 00~ Date of Meeting mil'' 2~ q~ ~~ ; Notices Mailed ~'~iJ-! ~ Secretary Refer Resolution to Building Department , ; Yes ; _; No .;.~ 000001 o-r Z NOTICE OF PIIBLIC HEARING TO ADJACENT PROPERTY OWNERS BEFORE THE PITKIN COUNTY BOARD OF ADJUSTMENT TO ALL PROPERTY OWNERS AFFECTED BY THE REQUESTED ZONING OR USE VARIANCE DESCRIBED BELOW: Pursuant to Pitkin County Resolution of June 5, 1955, as amended, a Public Hearing will be held in City Council Chambers, City Hall, First Floor, Aspen, Colorado (or at such other place as the meeting may then be adjourned) to consider an application filed with the said Board of Adjustment requesting authority for variance from the provisions of the County Zoning Resolution. All persons affected by the proposed variance are invited to appear and state their views, protests or objections. If you cannot appear personally at such meeting, then you are urged to state your views by letter, particularly if you have objection to such variance, as the Board of Adjustment will give serious consideration to the opinions of surrounding property owners and others affected in deciding whether to grant or deny the request for variance. THE PARTICULARS OF THE HEARING AND OF THE REQUESTED VARIANCE ARE AS FOLLOWS: Date and time of meeting: owner: Name and Address of Applicant: Property Location or Description: May 5, 1992 at 5:15 p.m. Commissioners Meeting Room, Courthouse Philip J. & Antonia Palmiotto Philip J. & Antonia Palmiotto 8240 County Rd. 115, #5 Glenwood Springs, CO 81601 Lot 21, Block 2 Crystal River Country Estates Requesting approval for a 50 foot front yard setback variance, where 100 feet is required in the RS-30 zone district, for construction of a single-family residence. Approval of this variance would place the proposed house 50 feet from the Palmiotto's front yard property line. VARIANCES GREATER OR LE88 THAN REQUESTED COIILD BE GRANTED. Duration of Variance: Temporary Permanent X THE TKIN COUNTY BOAR O' ADJUSTMENT Cindy L Christensen, Secretary UUUUU2 March 19, 1992 Pitkin County Planning Office 130 South Galena St. Aspen, CO 81611 To Whom It May Concern: We are requesting a variance from the setback requirements as required for Lot 21, Filing #2, Crystal River Country Estates Subdivision. This subdivision was platted and recorded in 1968 prior to any zoning being applied to this area. In the mid 1970's this area was zoned RS-30 and consequently the setbacks under this zone classification prevent building on this lot. We request the setbacks to be adjusted according to our building envelope as shown on the attached plat. This property went through the 1041 Hazard Review process and was approved on August 16, 1990. Sinc rely ~G^ ~ Philip lmiotto tonia Palmiotto .,~e.~ Jef •e ier `~-G. ,,,-~A- Eric A. Lawrence oouou~ '`'' N CRYSTAL RIVER COUNTRY ESTATES ADJACENT OWNERS OF LOT 21 Gay Spiegel 1318 Kenton Rd. Deerfield, IL 60015 (Lot 11) Thomas R. McBrayer 0074 Crystal Circle Carbondale, CO 81623 (Lot 20) Jeff & Pricilla Dickinson P.O. Box 533 Carbondale, CO 81623 (Lot 22) Robert J. & Evelyn Lorraine McGill 0535 Crystal Circle Carbondale, CO 81623 (Lot 12) 000004 M Mazch 19, 1992 Pitkin County Planning Office 130 South Galena St. Aspen, CO 81611 To Whom It May Concern: Philip J. and Antonia Palmiotto may act in our behalf on any matters connected with building, surveying, permitting or any issue as it pertain to Lot 21, Block 2, Crystal River Country Estates. Respectfully submitted, Je r M Bier Enc A. Lawrence P.O. Box 100 Carbondale, CO 81623 !• 0 0 o V V V Lot 21, Crystal River Country Estates is located appro~mately 8 miles south of Cazbondale on Highway 133 on the east side of the highway. 000006 ~ ;,~., r CANYON ~y s ~ t , ~` 'i-^'~YiiT v~t~ rixYi "c `a if~ • 'I1! ~t, a~xiY+ ~pFytp,tY~,'. right Peakl b' ~ h.'~~}i YU,603 ~ F1 ~ , &~ }Iq~ a~`', ' tt ~«~rtty, r t~l, fl "~r~;: i Y,tj ~>> ~~ ~ ~~ at t Y's , ~, ~ ~ ~r163~l~i i ~ tl ~ i , tai ~~~~.. ~~~ Y~~ i I,' '" ttpp f!~ ~' ~REDSTONE ~.}YE~~ oUnta a)R)vef~ ~ Red~lona Castleh, r•q•>ws•, -~ I e~5ione Ranch A ~~,.., cres I `A i aii , ,j r Mountain ti~ MAROON BELLS S N O W M A S S 1 I WILDERNESS 1 ~~ ' ~~.~ x ~ ~ outward ouhd ~saynbol - 14 ~' ILY LAKE I EAV~R~L~K£ ~.dl P~ ...... t i? , logy}; 1 70 boapnwoo esa; Y`' ~' ~C~g7 k ` ifl'.i\a~ ~~i:~#~fk't7~~1~3~^h~t, . ~'tlY YIr~ f r; rh aYlri7 vL 1!e k tl:: 1 R I~~i ,~. i -" r %~.AS 3i ail t.RI ILEC rksly''~ ib m.ir~gl~r rB9ta dv fe~ p„ r ~ +~Y! , jjyy I+,}i~r {f, i y R b A r p g jgi a Y ~ ~ \•~r ppp ~ 6~ H'~tt',~ ul~~'~f~ 4i ~x~>s+KY3' 8M° JI' h9 !~~~a , ' ' ~', ~' k Y~~r~ m ,~'~i~lYF~t ~~~~~ 13~ i ~gUeY Pd. 1SY ~ "1~ ~~~ ;. n ~, I~~Y"i Y ~ iiN .,S h,0 M9 rr t 1,. 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T s s 75 PITKIN RB9W 000008 CRYSTAL RIVER COUNTRY ESTATES & CRYSTAL VIEW HEIGHTS SUBDIVISION ~~ `ASPEN/PITKIM PLANNING OFFIC")' - - ~'~1~0 South Galena Street ._I - - ~ :Aspeh, Cobrado 81611 - - - _ - •(303) 920-5090 :.. ,. - ' LAND USE APPLICATION FEES = '- ' blryr ;; .. 00113 ~ ~ ~.-63250 134 .`:. .GMP/CONCEPTUAL ~ ~ ` ~ - - - - _ ~'-63270-136 ~~- "GMPIFINAL ~ -- - -- `~°~-63280-t37 "' ~' SUB/CONCEPTUAL - _-63300-139 SUB/FINAL ' - ~ ' -63310-t40 ALL 2-STEP APPLICATIONS -63320-741 ALL 1-STEP APPLICATIONS/ CONSENT AGENDA ITEMS REFERRAL FEES: 00125 ~-63340-205 ENVIRONMENTAL HEALTH 00123 -63340-190 HOUSING 00115 -63340-163 ENGINEERING SUBTOTAL County 00113 -63160-126 GMP/GENERAL -63170-127 GMP/DETAILED -63180-128 GMP/FINAL -63190-129 SUB/GENERAL -63200-130 SUB/DETAILED E3210-131 SU B/FINAL -63220-132 ALL 2-STEP APPLICATIONS 113230-133 ALL 1-STEP APPLICATIONS CONSENT AGENDA ITEMS -63450-146 BOARD OF ADJUSTMENT REFERRAL FEES: 00125 -63340-206 ENVIRONMENTAL HEALTH 00123 -63340-190 HOUSING 00113 -63360-143 ENGINEERING PLANNING OFFICE SALES 00113 -63080-122 CITY/COUNTY CODE -63090-123 COMP. PLAN -63140-124 COPY FEES Fi9000-145 OTHER Name: ~~ t ET~ t!'~= ~/~.. r) ~i/ !) , at Address: r~"-~ y J ~r, -~, .s~~ii ~ y Check # Copies received: .~ SUBTOTAL ~c~ TOTA/L Phone: -~`r`-~ ~~1~ ~~~ Project: 7/~ S ~~ %c'_ G]2-Z-7 Date: .,3 ~ / - ~- #otHOUrs: Q~~OIl`9 ~ , County of Pitkin } AFFIDAVIT OF NOTICE BY } ss. P03TING OF A VARIANCE HEARING State of Colorado } BEFORE THE PITRIN COUNTY BOARD OF ADJUSTMENT The undersigned, being first duly sworn, deposes and says as follows: I , ~~f 1//~ •Jt ~V"~/b~ N N~^~i2 f G ~i~l/oV r ~ being or representing an Applicant before the Pitkin County Board of Adjustment, personally certify that the attached photograph fairly and accurately represents the sign posted as Notice of the variance hearing on this matter in a conspicuous place on the subject property (as it~~codld`be seen from the nearest public way) and that the said sign was posted and visible continuously from the r/ ~~ day of ~~ ( 19~~, to the day of /"I~~ ~e~ , 19~. (Must be pasted for at least nine (9) full days Subscribed and sworn to before me this ~ day of 1~ , 19 ~.2.~ , by ~h/~/ ~ Ct /~ ~YIOL ~ ~h~l ~ A~t~l In r a WITNESS MY HAND AND OFFICIAL SEAL. My Commission expires: ~~ ~~ ~93 Notary Pyfblic's Sigr_ature ~~o~ may. /~~ Address/ ~" ~ ~ ~ /~~~ C,~itiY t~(~O~Qi; •,- , "': r %tj:j ~~ ---- i ' E t-:.' ~i..l~ i ' i ', Z ~,' ~~ 0 ~' • I i #345314 5/nl/9~ 15;47 Rec $.00 Pk: .'9 F'6 350 Silvia Davis, F'i tl::in Cnty Clerk, Doc ~.1~(~ RESOLUTION OF THE PITRIN COIINTY~ COLORADO BOARD OF ADJIISTMENT GRANTING SETBACK RELIEF FOR PHILIP 6 ANTONIA PALMIOTTO RESOLUTION NO. 92-21 WHEREAS, Philip and Antonia Palmiotto, owners of a tract of land situated at Lot 21, Block 2, Crystal River Country Estates, requests a 50 foot front yard setback variance, where 100 feet is required in the RS-30 zone district, for construction of a single- family residence; and WHEREAS, the subject property is within the unincorporated area of Pitkin County, Colorado (as described in Exhibit "A", attached); and, WHEREAS, the Board of Adjustment is vested with the power to grant or deny such variances by virtue of Title II, Section 16-1.3, Pitkin County Code (Land Use Code) and Colorado Revised Statutes, 1973, 30-28-118(2) (C); and, WHEREAS, based on the evidence presented, the Board of Adjustment makes the following findings: 1. Proper notice procedures, including the notification of all adjoining property owners, has been shown by the applicant. 2. The required hardship or practical difficulty has been established. 3. Granting such relief will not cause substan- tial detriment to the public welfare and will not substantially impair the intent and purpose of the Zoning Resolutions and the zoning maps. NOW, THEREFORE, BE IT RESOLVED by the Board of Adjustment, that a 50 foot front yard setback variance be granted due to downzoning, pursuant to the plans submitted (Exhibit "B"). WARNING: Any violation of the terms of this resolution may result in rehearing and possible revocation. ~ ODUU.~$ #345314 U6/ /9 15:47 Fec ~.C~U BFI 679 ; 351 Silvia Davis, PitF;in Cnty Clerk, Doc $.~~0 Resolution No. 92~L Page 2 The Resolution was adopted by vote of the Board of Adjustment of the County of Pitkin, State of Colorado. DATED: May 5, 1992 ATTEST: Cind L. Christensen, Secretary The Board of Adjustment of Pitkin County, Colorado Rick Neiley, Chairman 0~~~13 i #345314 ~~6/U1 /92 15:41 F;ec $.cw Pk:: 679 PG 352 Silvia Davis, Fitkin Cnty Clerk, Doc 2.~~c~ ~, t~ . ~~ ; ~..~ Lot 21, Crystal River Country Estates is located approximately 8 miles south of Carbondale on Highway 133 on the east side of the highway. ~ln^ni ~ ~ ;., ~~, ' #345314 c~6/~~175 15:41 Stec ~.0~~ PK 679 F• 3 Silvia Davis, Pitk:in Cnty Clerk, Doc x.00 ~-ast, i 25, oo' _ •o ~x L ; ~ ~ ~R ~~ G4.seme+~.~ l~ r 1 KJ ~ ni ~ L~ Lo-~. 21 a ~ {.o~ a~+ 4. M m em ~ J P' Pose. ,.5~ p~ SL 0. I L_ / /OV / ~Bu.i~dt. E+we~o e// ,_ ,t .^_ 1~ 30~ 1~ , .' ,- H a N 0 3 i 0 1 i Q~~~~~ ~.wcQ vebar __. NOTICE OF PUBLIC HEARING BEFORE THE PITICIN COUNTY BOARD OF ADJUSTMENT TO ALL PROPERTY OWNERS AFFECTED BY THE REQUESTED ZONING VARIANCE DESCRIBED BELOW: Pursuant to Pitkin County Zoning Resolution of June 5, 1955, as amended, a Public Hearing will be held in the District Courtroom, Prtkin County Court House, Aspen, Colorado, (or at such other place as the meeting may then be adjourned) to consider an application fled with the said Board of Adjustment requesting authonty for variance from the provisions of the County caning Resolution. All persons affected by the proposed variance are invited to appeaz and state their views, protests, or objections. If you cannot appeaz personally at such meeting, then you aze urged to state your views by letter, particulazly if you have objection to such variance, as the Board of Adjustment will give serious consideration to the opinions of surrounding property owners and others affected in deciding whether to grant or deny the request for variance. A VARIANCE GREATER THAN OR LESS THAN THAT REQUESTED COULD BE GRANTED. DATE AND T1114E OF MEETING: Tuesday, May 5, 1992 Commissioners Meeting Room, Courthouse Magoon, Nancy: requesting approval for an 80' front yard setback variance and a 3 foot north side yard setback variance, where 100' and 30', respectively, are required in the AF-1 zone district, for construction of an addition to asingle-family residence. Property Location: Lot R-73, Starwood Eleven. Palmiotto, Philip & Antonia: requesting approval fora 50' front yazd setback variance, where 100 feet is required in the RS-30 zone district, for construction of asingle-family residence. Property Location: Lot 21, Block 2, Crystal River Country Estates. JBJN Ltd. (John Armstrong): requesting an 80' front yazd setback variance and a 20' north side yazd setback variance, where 100' and 50', respectively, are required in the RS-30 zone district, for construction of a single-family residence. Property Location: Lot 8, Block 4, Second Filing, Gateway of Snowmass Mesa. Swiss Village Homeowners Association: requesting a 9' major road setback variance, where 50' is required per the Pitkin County Land Use Code, for construction of a facility to house a chlorination facility. Property Location: 10 miles south of Carbondale, on Highway 133; Confluence Avalanche & Crystal Rivers. Brewer, Jack: requesting a 3'6" front yazd setback variance and a 3'6" reaz yazd setback variance, where 30 feet and 10 feet, respectively, are required in the B-2 zone district; and a 3'6" arterial highway setback variance, for construction of an addition to a wazehouse. Property Location: Lot 1, Block 5, Aspen Airport Business Center. Submitted to the Aspen Times on April 21, 1992. To Be Published in the Aspen Times April 24, 1992. County PO N ~Q~~16 Minutes Pitkin County Board of Adjustment May 5, 1992 Members Present: Rick Neiley, Chairman Evan Gull Stan Mathis Ted Guy John Wheeler Rod Dyer Mike Cooper Staff: Joanna Schaffner, Zoning Enforcement Neiley opened the meeting at 5:15 p.m. and introduced the Board to those present. Michael Cooper was introduced to the Board as a new member. Joanna Schaffner addressed the Board stating that Lenny Oates, representing Martin Schlumberger, has requested this case be tabled to July 7, 1992. Guy moved to table Case x'92-18 until July 7, 1992, Mathis seconded the motion and all approved. Case #92-20 Maaoon Nancv Lot R-73 Starwood Eleven Ted Guy stated that he wanted the record to show that he and Stan Mathis are abstaining from voting on this case as Mathis is representing this case. Stan Mathis was present to request an 80 foot front yard setback variance, and a 3 foot north side yard setback variance, where 100 feet and 30 feet, respectively, are required in the AF-1 zone district, for construction of an addition to a single-family residence. Mathis briefed the Board on the history of this property, stating that it was previously before this Board requesting a 6 foot front yard setback variance, which was granted. Mathis stated that previously the southeast side was considered the front yard. Mathis showed the Board the site plan and what is being requested. A kitchen addition would further extend up the hill into the corner of the site. The proposed addition would be back behind the house and would not affect the adjacent homeowners. Mathis stated that the lot is approximately 2.15 acres making this a nonconforming lot. Starwood Homeowner's Association has given their preliminary approval for the proposed addition. i 000017 There was no public comment. After further discussion, Wheeler moved to grant an 80 foot front yard setback variance and a 3 foot north side yard wetback variance, due to downzoning and practical difficulties. The Board has also determined that the front yard shall be the side along Danielson Drive. Dyer seconded the motion. All were in favor. Case #92-21 Palmiotto Philip Lot 21 Block 2, Crystal River Country Estates Rod Dyer and Michael Cooper will not vote on this case. Philip Palmiotto was present to request a 50 foot front yard setback variance, where 100 feet is required in the RS-30 zone district, for construction of a single-family residence. Palmiotto stated that the zoning on this property is RS-30. The lot is only 125 feet in depth and it would make it impossible to build a home with a 100 foot front yard setback. Guy stated that the covenants for Crystal River Country Estates do not have any specific setback requirements. There was no public comment on this case. After a brief discussion, Guy moved to grant a 50 foot front yard setback variance due to downzoning, as per the plans submitted. Wheeler seconded the motion and all were in favor. Motion passed. Case #92-22 JBJN Ltd (John Armstronal, Lot 8, Block 4, Filin4 2 ~atewav of Snowmass Mesa Rick Neiley and Evan Gull will not vote on this case. John Spencer was present representing JBJN to request an 80 foot front yard setback variance and a 20 foot north side yard setback variance, where 100 feet and 50 feet, respectively, are required in the RS-30 zone district, for construction of a single-family residence. The lot is a nonconforming lot with .91 acres. The lot is a very steep lot which will require a steep driveway onto the property. Neiley asked why the location of the proposed home has to be so close to the front lot line. Spencer stated that if the proposed home is moved further down the hill, the grade of the road will be increased. Mathis asked if the plans had to be reviewed by the Homeowner's Association. Spencer did not know, but stated that John Armstrong had taken the plans to a Homeowner's Meeting last year, but was not sure what the outcome was. 2 OUOU18 Neiley asked for public comment. Patrick Kiltie asked where this house would be located in relation to Lot 7. Spencer stated that it would be behind and above it. Gull believed that the covenants for Gateway of Snowmass Mesa had the requirement of a 25 foot front yard setback variance. Guy asked Spencer if the house could be moved back. Spencer stated that he believed it could be. After further discussion, Guy made a motion to grant a 75 foot front yard setback variance and a 20 foot north side yard setback variance, due to downzoning and topographical hardship. Dyer seconded the motion and four were in favor, with Wheeler voting no. Motion passed. Dean Derosier (McLaughlin Water Engineers) and Nicki Lee (Swiss Village Homeowner's Association) were present representing the Swiss Village Homeowner's Association and the Mollicas, to request a 41 foot major road setback, where 50 feet is required per the Pitkin County Land Use Code, for construction of a chlorination facility. (Please note: The notification was made for a 9 foot major road setback variance, where 50 feet are required. It was decided by the Board that since all postings have a stipulation on them stating that a greater than or less than variance could be granted, further notification and review was not necessary.) Derosier stated that the existing water system that feeds Swiss Village does not meet any State Health codes. The State has requested that Swiss Village immediately update their water system and bring it under compliance. The chlorination facility needs to be as close to the well site as possible. This property is owned by the Mollicas and would be hidden by many trees. This facility will be built to resemble the Mollicas' cabins. Derosier submitted pictures to the Board. Schaffner spoke with Chuck Dunn at the Highway Department on May 5, 1992, in which he expressed that the Highway Department had no concerns with the proposed development. Neiley also read the April 5, 1992 letter from Jim and Sharon Mollica into the record supporting this request. There was no public comment. After further discussion, Neiley moved to grant a 41 foot major road setback variance due to practical difficulties. Guy seconded the motion. All were in favor. 3 000019 Case #92-25 Brewer Jack Lot 1 Block 5 AABC Ted Guy and Stan Mathis will step ,down because of potential conflicts with this case. Tim Hagman was present, representing Jack Brewer, to request a 3 foot 6 inch front yard setback variance and a 3 foot 6 inch rear yard setback variance, where 30 feet and l0 feet, respectively, are required in the B-2 zone district; and a 3 foot 6 " arterial highway setback variance for construction of a new roof to an existing warehouse. Hagman submitted pictures showing the existing building, and gave a brief history of the building. Range Rover wants to put a dealership and service center in this building., To tie in with the historic character of the building and honor its historic significance in the area, the design of this addition is compatible with the existing building. Letters of support from John McBride, Steve Hansen and Stephen McDonald were read into the record. There is also a letter of support in the file from Roxanne Eflin, Aspen/Pitkin Historic Preservation Officer. There was no public comment on this case. After further discussion, Gull moved to grant a 3 foot 6 inch front yard setback variance, a 3 foot 6 inch rear yard setback variance, and a 3 foot 6 inch arterial highway setback variance, due to the unique conditions of the property not caused by the applicant and practical difficulties, pursuant to the plans submitted. Dyer seconded the motion and all were in favor. The minutes were approved with the change made by Ted Guy mentioning that Bob Gruder (for the Schlumberger case) was representing Wade Kent. The meeting was adjourned at 6:40 p Resp ctfully sub fitted, Cindy Ch istensen, Secretary 'm.n '1 ,~~~ ~ . kick i ei. y, Chairman ~.., 000020 ASPEN/PITKIN PLANNING OFFI~ 130 South Galena Street Aspen, Colorado 81611 (303)920-5090 LAND USE APPLICATION FEES city 00113 -63250-134 GMP/CONCEPTUAL -63270-136 GMP/FINAL -63280-137 SUB/CONCEPTUAL -63300-139 SUB/FINAL -63310-140 ALL 2-STEP APPLICATIONS 63320-141 ALL 1-STEP APPLICATIONS/ CONSENT AGENDA ITEMS REFERRAL FEES: 00125 -63340-205 ENVIRONMENTAL HEALTH 00123 -63340-190 HOUSING 00115 X3340-163 ENGINEERING SUBTOTAL County 00113 -63160-126 GMP/GENERAL -63170-127 GMP/DETAILED -63180-128 GMP/FINAL -63190-129 SUB/GENERAL -63200-130 SUB/DETAILED -63210-131 SUB/FINAL -63220-132 ALL 2-STEP APPLICATIONS -63230-133 ALL 1-STEP APPLICATIONS CONSENT AGENDA ITEMS -63450-146 BOARD OF ADJUSTMENT REFERRAL FEES: 00125 -63340-205 ENVIRONMENTAL HEALTH 00123 -63340-190 HOUSING 00113 -63360-143 ENGINEERING PLANNING OFFICE SALES 00113 -63080-122 CITY/COUNTY CODE -63090-123 COMP PLAN -63140-124 COPY FEES -69000-145 OTHER Name: ~' ~ r ~; B~ ~), „~ ~-r^/ Address: - '/ ~ ~ ,• ~i !! .; "' ~~ Check # ~ ~' ~ ~~ Copies received: G SUBTOTAL - ~- TOTAL~~- '' // -----_ Phone:-L~i`S ~r )~l I ~~Z-Z~ ,. Date: ~ -~+~ ~' 1 ~_.