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2. Owner First Name *
3. Last Name*
4. Mailing Address*
6. Email Address*
7. Phone Number
9. Street Address*
10. Legal Description*
    Please include Subdivision Lot and Block # or Township Range Section
11. Parcel Number
13. Responsible Party First Name*
14. Last Name*
15. Mail Addresss*
17. Email Address*
18. Phone Number
20. Please give a brief description of what the project is about*
21. Is the applicant the owner of the property legally described above?

    1. yes
    2. no
22. If not, please explain
24. Does the applicant own property adjacent to the area proposed for development?

    1. yes
    2. no
25. If yes, please explain
26. Present Land Use
27. Brief explanation of reason or intention for requested action:
29. Are the streets owned

    1. privately
    2. publicly
31. Existing Dedications
    Please itemize all existing accesses, ROWs, easements, and dedications affecting subject property.
32. Proposed Dedications
    Please itemize all proposed accesses, ROWs, easements, and dedications affecting subject property.
33. Special Studies
    Please itemize any special studies, i.e. floodplain remapping, avalanche studies, or water rights investigations which are submitted with this proposal.
35. CHECKLIST
    In order for an application to be considered complete, all the final plat data required in Chapter 4, Title 10 (Subdivision Ordinance) of the Blaine County Code must be submitted to the Planning and Zoning Office. A simplified checklist of these requirements follows: Plat: - 1:200 scale; - North arrow; - Title block, including the name of the proposed subdivision, date prepared, applicant's name, and project coordinators (engineer, surveyor, developer, etc.); - Accurate boundary survey; - Scaled location of existing buildings, water bodies, water courses, and public easements on or adjacent to the property; - Proposed location of street ROWs and easements; - Proposed location numbering of lot and block lines; - Delineation of floodplain and/or floodway lines as determined by FEMA, if applicable; - Ordinary high water mark, riparian setback district - Avalanche lines, if applicable; - Location, size, and proposed use of all land intended to be dedicated or reserved; and - Proposed location of all building envelopes.
36. Additional Information (please attach the following):
    - Legal description of subject property, if not included in application; - Proof of ownership, if applicable; - Information regarding existing/proposed dedications, i.e., easements affecting subject property; - Vicinity map showing all properties within ½ mile @ 1:1000; - Map showing names of surrounding landowners within 300 feet of the exterior boundary of subject property, including private road owners. If within a subdivision, show names of all subdivision lot owners. Names and addresses of all Land owners, including private road owners, typed on mailing labels. - If some other type of permit is required as part of the proposed development, please attach the appropriate application or consent of approval - Six (6) copies of the amended plat, 2 copies for “minor amendments” per §10-4-7(D). - 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 and returned by the applicant as soon as possible after the hearing. - Application fee of $300.00 and current postage + .15¢ per surrounding land owner mailing fee.
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field