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2. Name*
3. Email Address
5. Address*
7. Phone Number*
8. Fax Number
10. Responsible Party information*
12. Mailing Address*
13. Are you the *

    1. Owner
    2. Renter
    3. Property Manager
14. Street Address*
15. Size of Tract
17. Present Land Use
18. Existing Zoning
19. Overlay Districts
20. Requested Action
22. Legal Description (include Subdivision or Township, Range and Section)*
23. RP Number
24. Is the applicant the owner of the property?

    1. yes
    2. no
25. If no, please explain
27. Does the applicant own property adjacent to the area proposed for development?

    1. yes
    2. no
28. If yes, please explain
30. Please attach the following items
    a) Septic permit and letter from the South Central Health District. b) Proof of ownership. c) Vicinity map which includes all lands within ½ mile of subject property. d) Lot and parcel map available from the County Assessor's Office. The applicant is responsible to accurately indicate the names of surrounding landowners, including private road owners, on the map. e) The names and addresses of surrounding landowners within 300' of the exterior boundary of the subject property, including private road owners, are to be typed onto self-adhesive copier labels. f) Three (3) copies of the proposed site plan showing: - Property line and north arrow; - Existing and proposed easements; - Location of all existing and proposed structures; - Exterior building elevations and floor plans for proposed structure(s); - Drainage plan; - Grading plan showing existing and proposed grade changes; - Outdoor lighting plan; - Existing and proposed landscaping including irrigation methods; - Existing and proposed fencing; - Location of utilities including electric, gas, well, septic tank and drain field(s); g) Typed responses to attached Standards of Evaluation “3” and “4” attached herewith. h) A description of the existing land uses on the parcels of land located within 300' of the exterior boundary of the property being evaluated; I) A refundable “Notice” fee of $50.00 for a Notice board to be posted on site of property being considered for at least 7 days prior to public hearing. j) * Application fee of $450.00 as established by County Fee Resolution plus current postage + .15¢ per surrounding land owner mailing fee. k) There may be County Engineer review fees in addition to application fee.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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