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2. First Name *
3. Last Name*
4. Mail Address*
6. Email Address*
7. Phone Number
9. Street Address*
10. Legal Description*
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
28. Estimate quantities of work involved:
29. Total area (s.f. or acreage) of disturbance:
30. Amount of fill (c.y.) to be brought in:
31. Amount of graded material (c.y.) to be taken off-site:
33. Date proposed areas of disturbance are staked and are ready for administrative review:
35. Please include the following
    Attach a report and plans, (8 copies required), including text, designs, and visual representations including simulations, which indicates how the design and construction of improvements will mitigate visibility, and also include specific engineering, public safety, revegetation, site review, building and other information in sufficient detail to demonstrate compliance with the design review standards of evaluation contained in Section 9-21-5 D of the County Code. Where applicable, the report shall include a visual resource contrast rating worksheet as required by the Administrator. (10) Attach a graphic representation of the proposal (8 copies required) which shall include property lines and delineate the proposed areas for improvement or alteration, alternative site locations, existing and proposed contours, drainage and drainage structures, landscaping and revegetation plans, including plan for the control of noxious weeds, and location for placement of the drain field and retaining walls. (11) Slope and elevation analysis by a licensed engineer or surveyor as required by Section 9-21-2 (E), and a report from a licensed engineer describing the risks of soil erosion, silting of lower slopes, slide damage, flooding, severe scarring or any other geological instability associated with the site alteration, and plans for mitigation of those risks. (12) Response to the attached Design Review Standards of Evaluation as set forth in Section 9-21-5 D. (14) Attach the following documentation (8 copies): (a) Written evidence that South Central Health District (SCHD) has reviewed the site and determined that the property is found appropriate for on-site sewage disposal. (b) Written input from the applicable rural fire district (or building official if the subject property is outside an established fire district) addressing adequacy of the proposed access for emergency vehicles and compliance with fire protection requirements. Recorded Deed (c) Written input from the County Engineer addressing, but not limited to, compliance with road standards, drainage, and erosion mitigation. (15) Include map showing names of surrounding landowners within 300 feet of the exterior boundary of subject property, including private road owners. Attach names and addresses of surrounding landowners, including private road owners, typed on mailing labels. Information available from County Assessors Office. (16) Include an exterior lighting plan, showing all aspects of exterior lighting relating to building, landscape and any other lighting. Include manufacturer catalog cuts for all fixtures. (17) Include application fee of $500.00 and current postage + .15¢ per surrounding land owner mailing fee. REQUIRED FIELD ACTIVITIES (18) 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.
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

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