Conditional Use Permit Application Form - Grant County Government

More documents

Recommendations

Info

PART IIILEGAL OWNER SIGNATURE(Signature of legal owner or representative as authorized by legal owner)I, the undersigned, swear or affirm under penalty of perjury that the above responses are madetruthfully and to the best of my knowledge.I further swear or affirm that I am the owner of record of the area proposed for the previouslyidentified land use action, or, if not the owner, attached herewith is written permission from the ownerauthorizing my actions on his or her behalf.Name: __________________________Address: ________________________________________________________Date: ______________________________Phone: _____________________________Zip: ______________________________________________________________________Signature of Applicant or representative____________________________________DateSTATE OF WASHINGTON ) ss:COUNTY OF GRANT )Notary(For Part III Above)SUBSCRIBED AND SWORN to me this ______ day of _______________, 20____.NOTARY SEAL_________________________________Notary SignatureNotary Public in and for the State of WashingtonResiding at: ____________________________My appointment expires: __________________PART IV(To be completed by the Planning Department)Date Submitted: _________________________ Planner: _______________________________Total Fees: _____________________________ Receipt #: ______________________________File #: _________________________________ Complete Application: ___________________Conditional Use Permit Adopted 3/99, Fee chg 5/09Application - 6 - Resolution #09-037-CC
Critical Areas ChecklistPursuant to Grant County 24.08.0701) Section ______ Township ______ Range ______ Parcel Number ___________________2) Site Address:______________________________________________________________________3) Directions to site and landmarks to help staff locate the site:___________________________________________________________________________________________________________________________________________________________________________________________________4) If this checklist is submitted independently, please attach a Section map obtained from the Assessor’soffice and highlight the project area. Attached? Yes ___ No ___5) Proposed uses: ____________________________________________________________________6) For independent CAO review, please attach a Site Plan. Attached? Yes ___ No ___7) Please answer the following questions concerning Critical Area indicators located on or within 300feet of the project area.a) Are you aware of any environmental documentation that has been prepared related to criticalareas that includes the subject area? (if yes, please attach a list of document titles).Yes ___ No ___ Unknown ___b) Are there any surface waters (including year-round and seasonal streams, saltwater, lakes, ponds,bogs, fens, swamps, marshes)?Yes ___ No ___ Unknown ___c) Is there vegetation that is associated with wetlands?Yes ___ No ___ Unknown ___d) Have any wetlands been identified?Yes ___ No ___ Unknown ___e) Are there areas where the ground is consistently inundated or saturated with water?Yes ___ No ___ Unknown ___f) Is there any State or Federally listed sensitive, endangered or threatened species and habitats?Yes ___ No ___ Unknown ___g) Are there slopes of 15% or greater?Yes ___ No ___ Unknown___h) Is the project located within a Flood Hazard Zone?Yes ___ No ___ Unknown ___i) Do you know of any geologic hazards (for example: erosion hazards, landslide hazards, seismichazards and mine hazards)?Yes ___ No ___ Unknown___j) Do you know of any cultural resource sites (lands, sites, structures with historic or archaeologicalsignificance) located on the proposed site?Yes ___ No ___ Unknown___Information regarding endangered species, wetland vegetation and flood hazard zones is available forpublic use at the Grant County Planning Department. I understand that if the information on this form islater determined to be incorrect, the project or activity may be subject to conditions or denial as necessaryto meet the requirements of GCC 24.08, the Grant County Critical Areas Ordinance.__________________________________Applicant’s Signature_____________________Date
Page 1 and 2: Grant CountyDepartment of Community
Page 3 and 4: Conditional Use Permit - Responses
Page 5: List Previous Grant County Actions
Page 9 and 10: SITE PLAN INSTRUCTIONSINSTRUCTIONS:
Page 11 and 12: GRANT COUNTY HEALTH DISTRICTPO BOX

Conditional Use Permit Application Form - Grant County Government

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?