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2. Owner First Name *
3. Last Name*
4. Mailing Address*
6. Email Address*
7. Phone Number
9. Applicant or Agent First Name*
10. Last Name*
11. Mail Addresss*
13. Email Address*
14. Phone Number
16. Street Address*
17. Legal Description*
    Please include Subdivision Lot and Block # or Township Range Section
18. Parcel Number
20. Please give a brief description of what the project is about*
21. Present Land Use
23. Required Setbacks
    Front- Side- Rear-
24. Requested Setbacks
    Front - Side - Rear -
25. What undue hardship shall occur if this variance is not granted?
27. Describe any impacts which would be created by granting the variance AND steps the applicant proposes to offset these impacts.
28. Please itemize neighboring properties that currently intrude into County setbacks
30. Legal Description*
    Please include Subdivision Lot and Block # or Township Range Section
31. Parcel Number
33. Is the applicant the owner of the property legally described above?

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

    1. yes
    2. no
37. If yes, please explain
39. Please submit the following items:
    a) Legal description of subject property, if not included above. b) Proof of ownership. c) Septic Permit or a letter of approval from the South Central District Health. d) Vicinity map which includes all lands within ½ mile of subject property. e) Lot and parcel map. This map can be purchased in the Assessor's Office and the applicant shall include the names of surrounding landowners on it. f) Names and addresses of surrounding landowners within 300' of the exterior boundary of subject property, including private road owners. Names and addresses are to be typed onto self-adhesive copier labels. g) Three (3) copies of site and landscaping plan indicating the proposed location of the building envelope, any changes in present elevations due to grading, and the type and location of existing and proposed planting materials. h) Three (3) copies of Building elevations and floor plan; description of building materials including roofing. i) $600 variance application fee plus current postage + .15¢ per surrounding land owner mailing fee. County Engineer fees may be assessed in addition to application fee. These fees will be billed by the Land Use office and are payable before the application is considered at public hearing. j) Typed and complete responses to attached Criteria for Review. k) 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.
41. ACKNOWLEDGMENT
    The undersigned certifies that (s)he is the owner of the subject property, or an authorized representative, that (s)he has filled in this application to the best of his/her knowledge, and that (s)he agrees to comply with all county codes and state laws, as amended, regulating properties in Blaine County, Idaho. The applicant agrees in the event of a dispute concerning the interpretation or enforcement of the variance permit, in which the County is the prevailing party, the applicant will pay reasonable attorney's fees and costs, including fees and costs of appeal for the County of Blaine. The undersigned grants permission to County Personnel to inspect any property which is the subject of this application until such time as all condition(s) of approval attached to the application(s) have been satisfied.
43. Signature of Owner/Authorized Agent
44. Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field