Columbine Lake Country Club, Inc.

P. O. Box 714

Grand Lake, CO 80447

(970) 627-8120

Variance Request Form

The Declaration of Protective Covenants, Restrictions, Easements, and Reservations for Columbine Lake Country Club, Inc. state in Article I.B.(5) that, The Board of Directors “may issue a specific use permit in situations where unique and special circumstances such as shape of the lot, topography of the lot, unusual and necessary requirements of the certificate holder, or other circumstances which, in the judgment of the Architectural Control Committee, indicate that the use requested by the certificate holder would not frustrate the requirements of these restrictive covenants, and which, if a specific use permit were not granted, would work an unnecessary and undue hardship upon the certificate holder.”  A variance request must be approved by the Board of Directors, and a specific use permit issued in order to deviate in any way from the Protective Covenants.  There is a fee of $25.00 for variance consideration that must be submitted with this form.

Owner’s Name _____________________________________________ Block ________ Lot _______

Mailing Address _______________________________City, State, Zip _________________________

Phone #'s: Home: ________________ Work: __________________ Grand Lake: _________________

Detailed Variance Request (Attach diagram):____________________________________________

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Reason(s) for Variance Request: ______________________________________________________

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Attach adjacent neighbor(s) input in writing with signature:

Name: _______________________________                       Name: ____________________________

Address: _____________________________                        Address: ___________________________

City, State Zip:  ________________________                       City, State Zip:  _____________________

Grand County position (if required): __________________________________________________

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(Additional pages may be attached in order to meet the variance request requirements.)

For Office Use Only:

ARC recommendation: _____________ Date Received in Office: _____________ Amount: _________

Board Approval Granted: _____________ Denied _________