HomeMy WebLinkAboutAg. Employee Housing Affidavit 06.06.2020Garfield County
A(CRICULI l.RAI. EMPLOYEE AFFIDAVIT
FOR F,MI'LOYFE HOUSING
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S /'//7E"/) E:t�= . state that the residential structure
described below will he occupied solely as an agricultural employee dwelling unit
without rent provided to an individual and related family marcher who is/are employed in
an agricultural use, including farms, garden, greenhouse, nursery, orchard, ranch, small
animal farm for production of poultry, fish, furbcaring or other small animals, as
prescribed in the Garfield County Land Use and Development Code. 1 lurcher state that
the residential structure is located on Agricultural Land defined in Article 15 oldie
Garfield County Land Use and Development Code.
It is agreed that proof -of -employment, in the fbrn of -Internal Revenue Service Forms
W-2 or 1099 for each person employed as described above will he submitted to the
Garfield County Community Development Department upon request by the county.
Failure to provide this information for each year the unit is occupied will result in a code
violation, revocation of this status, and fines allowed by law.
Itis agreed that this property will not be sold to another party without representing that
(he agricultural employee dwelling structure is for agricultural employees only and may
not be used for any other purpose.
Property and Building Description:
Address_ ��5 C` ll /1 ' - /z)
3
Assessors Parcel Number _Jo C Q
Building Description_
Building Square Feet 1 labitable '_`' /E _ 's, /4'` '016-4 4 -?" r c c " J�' y 6 (e;. 41,
Building Permit Number 07, ..--?I.s4:`,/
ISDS (Septic) Permit Number 1773 1-;s24 14-) sepll r /t k,)
Owner_ .
Owner Address Z .
Date_ ; ?.Z d u
Witness
0-160 (Signature)
fid, r p 2 'e _ (;,6.-/21_:,,07, 271/ 2//Z,6
This form will be recorded with the Garfield County Clerk and Recorders office as
reference for any future title searches.
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and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Road Impact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their.representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereby acknowledge I have read, understand and will abide by the requirements of this
checklist.
A:/dh s- /�•l
Property Owner Print and Sign
Date