Conditional Use Permit Application Form - Grant County Government

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All requested information shall be provided - use black ink or type for photocopying purposesPART IICONDITIONAL USE PERMIT APPLICATIONLegal Owner’s Name: _______________________________________________________________Mailing Address: __________________________________________________________________City: _______________________ State: ________________ Zip: ________________________Phone: ______________________ (Work): ______________ Fax: ________________________If applicant is not the owner, include the written owner authorization form below designating thecontact to serve as representative.Owner’s Designated Contact: _________________________________________________________Mailing Address: ___________________________________________________________________City: _______________________ State: ________________ Zip: ________________________Phone: _____________________ (Work): _______________ Fax: ________________________Project/Proposal Site Area (Acres or sq. ft.): ______________________________________________Assessor Tax Parcel No.(s) of Proposal Site: _____________________________________________Adjacent Area Owned or Controlled (Acres or sq. ft.): ______________________________________Assessor Tax Parcel No.(s) of Adjacent Land Owned or Controlled: ___________________________Street Address of Proposed Site (if any): __________________________________________________________________________________________________________________________________Describe Existing Use(s) on Proposed Site (Such as buildings, well, sewer drainfield and others):_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Existing Zoning Classification: _______________________________________________________Comprehensive Plan Category: _______________________________________________________Growth Management Act Designation: Within IUGA or UGA? ( ) yes ( ) noSchool District: ____________________________________________________________________Fire District: ______________________________________________________________________Water Purveyor: ____________________________________________________________________Irrigation District: __________________________________________________________________Proposed Use of Property:( ) Duplexes ( ) Business ( ) Multi-Family dwelling( ) Industrial ( ) Mixed Use ( ) Single-family dwelling( ) Manufactured Homes ( ) Other: Please describe______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Conditional Use Permit Adopted 3/99, Fee chg 5/09Application - 4 - Resolution #09-037-CC
List Previous Grant County Actions Involving this Property: (Such as tax segregation application,certificate of exemptions, GA or EA affidavit, subdivision, lot segregation or Agriculture Districtsegregation, zone change, variance, temporary use SEPA review, estate transfer, zoning code violationor others) ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________LEGAL INFORMATIONLocation of Proposal Site (General description by which direction and how far from roads andintersections and other community features): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Section(s): _____ Township: ______ Range: _______ Legal description attached: ( ) yes( ) noName of Public Road (s) providing access: _________________________________________________________________________________________________________________________________Width of Property Fronting on Public Road: ______________________________________________Section of the zoning ordinance under which it is claimed that a conditional use should be granted:__________________________________________________________________________________Purpose for the requested conditional use: ___________________________________________________________________________________________________________________________________________________________________________________________________________________Is the proposed use to be temporary or permanent? If temporary, please explain: ____________________________________________________________________________________________________________________________________________________________________________________If you have any additional comments, please attach them on a separate sheet of paper.Conditional Use Permit Adopted 3/99, Fee chg 5/09Application - 5 - Resolution #09-037-CC
Page 1 and 2: Grant CountyDepartment of Community
Page 3: Conditional Use Permit - Responses
Page 7 and 8: Critical Areas ChecklistPursuant to
Page 9 and 10: SITE PLAN INSTRUCTIONSINSTRUCTIONS:
Page 11 and 12: GRANT COUNTY HEALTH DISTRICTPO BOX

Conditional Use Permit Application Form - Grant County Government

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