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ELBERT COUNTY GOVERNMENT (Elbert County Government)

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CDS Registration number: _________
Industrial Hemp Cultivator Application Form
Purpose: Implements Elbert County Ordinance 18-01: (12/19/2018). Collects information from applicant; may be used for multiple purposes,
including law enforcement.
Current Form Adopted: 1/24/2019
Page 1 of 3
ELBERT COUNTY GOVERNMENT
Community and Development Services
cds@elbertcounty-co.gov
CDS Phone: 303-621-3185
PO Box 7, 215 Comanche St, Kiowa, CO, 80117
Elbert County Industrial Hemp Cultivator Application Form
Dat
e of Application:
St
ate: Zip:
Alt
ernate phone:
Registrant Name:
DBA: (If Applicable)
Mailing Address:
City:
Mailing Address:
Work
phone:
Email:
Website: (If Applicable)
Please Note: A valid form of government-issued identification will be reviewed when submitting this Application in
person, and must be provided with any Application submitted electronically.
Identification of Land Area
Physical Address of Operation:
City, Zip Code:
Legal Description:
Township: Range: Section:
GPS Coordinates (Lat/Lon): Latitude: Longitude:
Outdoor Acres:
Greenhouse Square Footage:
Zoning of Registered Land:
Does the applicant have water rights at the site, and will irrigation methods conform to
agricultural common practices?
YES NO
If you checked “No” above, please describe your alternative irrigation method(s):
Please Note: Applicant and Land Area information must match your Colorado Department of Agriculture (CDA)
Application (March 2018). You must also submit a copy of your approved CDA Application with this Elbert County
Application.
CDS Registration number: _________
Industrial Hemp Cultivator Application Form
Purpose: Implements Elbert County Ordinance 18-01: (12/19/2018). Collects information from applicant; may be used for multiple purposes,
including law enforcement.
Current Form Adopted: 1/24/2019
Page 2 of 3
Proof of State Registration Attached.
I agree to inform Elbert County of any changes to my Colorado Department of
A
griculture Industrial Hemp Application when applying for CDA approval of such
changes, and notify the county when approved by CDA.
Attached Letter indicating intended in-County use for hemp not sold or shipped out
of County, OR proof of contract for sale/proof of contract for processing hemp with
an entity outside of Elbert County, signed by both cultivator and processor.
Please Note: Elbert County does not currently allow processing of Industrial Hemp into
byproducts within the County.
Additional Requirements and Acknowledgements
Initials _____ I acknowledge the Elbert County Community Development Services requirement
to submit proof of potency testing by a Colorado state-certified laboratory, at
cultivator cost, for all varietals planted within each registered area, no sooner
than twenty-one (21) days prior to harves
t.
Note: Elbert County also encourages cultivators to voluntarily submit any potency
testing reports conducted for quality control, experimental, or any other reason, at
any time to CDS.
Initials_____ I acknowledge the Elbert County Community Development Services requirement to
submit a copy of your CDA-mandated planting and harvest reports no more than
fifteen (15) days after planting or transferring cannabis plants in and within a
registered land area; and no sooner than twenty-one (21) days and no later
than seven (7) days prior to the anticipated harvest date.
Initials _____ Attached copy of Destruction Plan, applicable if crop tests above 0.3% THC.
Initia
ls _____ Attached letter of acceptance from your applicable Fire District, if your destruction
plan includes burning.
Initia
ls _____ I acknowledge the Elbert County Sheriff’s Office requirement to provide unimpeded
access to the cultivation site and all buildings registered for cultivation within 24
hours of notification.
Initial
s _____ I acknowledge the Elbert County CDS requirement to provide unimpeded access
to the cultivation site and all buildings registered for cultivation within 24 hours for
the purpose of site inspection and testing up to two (2) samples per year from any
varietal on each registered land area within the county, to be tested for potency by
a state-certified laboratory at cost to the County.
Initia
ls _____ I acknowledge that when any cultivation takes place within any structure,
compliance with all applicable laws, regulations, and codes, including but not
limited to health, building, electrical, plumbing, mechanical, sign, fire, and other
codes, statutes, and ordinance will be followed.
CDS Registration number: _________
Industrial Hemp Cultivator Application Form
Purpose: Implements Elbert County Ordinance 18-01: (12/19/2018). Collects information from applicant; may be used for multiple purposes,
including law enforcement.
Current Form Adopted: 1/24/2019
Page 3 of 3
Yes No If the registrant grew hemp in the County in the previous year, proof of testing from
the prior year showing THC level for all hemp varietals planted in each
registered area
fell within the 0.3% THC content or below threshold.
Signage and Security Requirements
Yes No Is the cultivation site or all buildings registered for cultivation fenced
along boundaries where the site or buildings are adjacent to public access
roads, and along boundaries with adjacent properties?
Elbert C
ounty requires the fence establishes a clear boundary for the site and creates a “deterrent
effect” to discourage trespassing onto the property. A fence averaging at least 48 inches above
ground level, comprised of three barbed wire strands with no more than 15 inch spacing, chain
link, or three-rail wood, metal, or vinyl fence are typical examples deemed to have both boundary
and deterrent effects.
Yes No Does the cultivation site or all buildings registered for cultivation have clear
signage indicating the presence of industrial hemp at the property entrance,
along all public access roads, and along boundaries with adjacent
properties?
Elbert County requires signage be placed no more than 150 feet apart along a single boundary,
at the center point of a single boundary and at all corners of the property, at any access point to
the property from a public road, and/or at all entrances to fixed structures used for indoor
cultivation. The signage should be readable from at least 25 feet away.
Initials _____ I acknowledge that failure to comply with any of the above requirements may result
in denial of a permit for the subsequent registration year and/or fines to be assessed
in the current year.
Additional
Notes:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Collection of Fees
Base Permitting Fee $500.00
Applicant Signature and Date:
Communit
y Development Services Payment and Application Received by Name and Date:
PERMITS ARE VALID FROM JANUARY 1 THROUGH DECEMBER 31
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ELBERT COUNTY GOVERNMENT (Elbert County Government)

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Completed 21 January 2021

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