Fill - Free fillable Cascade County Special Use Permit Application (Cascade County) PDF form

Cascade County Special Use Permit Application

Cascade County Planning Department

121 4

th

St N, Suite 2H-2I

Great Falls, MT 59401

Phone: 406-454-6905 Fax: 406-454-6919

Page 1 of 9

Permit No:____________

App. No.: _____________

Applied Date:__________

Updated May 14, 2019

General Information

A Special Use Permit (SUP) is required for uses in which conformance to additional standards will be required due to

characteristics that are unique and special to the use. SUPs are to be issued for one specific use and are required for

each tract o

f land. Legally issued SUPs shall expire one year after the date of approval if construction, or the use

permitted, has not started. A one-time only six (6) month extension may be granted by the Zoning Board of Adjustment

(ZBOA) upon request. SUP applications require a non-refundable application fee of four hundred and fifty dollars

($450.00). Each SUP application shall be accompanied by an Location/Conformance (L/C) Permit application for

changes in use and/or structures associated with the SUP application.

Application Information

Propert

y Owner Name:

__________________________________________________________________________

Applicant Name:

__________________________________________________________________________

Application Type:

☐ Change of Use ☐ New Structure(s)

Special Use Call Out:

__________________________________________________________________________

Understanding the Regulations

The proposed use must be specifically mentioned as a category in Uses Permitted Upon Issuance of a Special Use Permit

within Section 7 of the Cascade County Zoning Regulations. Portions of the County Zoning Map and the Zoning

Regulations are available at the Cascade County Website at

http://departments.cascadecountymt.gov/planning.

Steps of the Application Process

(1) Schedule a Pre-Application meeting with planners to ensure the project will meet the standards for Special Use

Permits as outlined within Section 7 of Cascade County’s Zoning Regulations.

(2) Complete, sign and submit a Special Use Permit application, Location/Conformance Permit application and a Use

Statement Form, with the $450.00 application fee to Planning Staff.

(3) Diagrams, business plans, photographs and other documents may be requested as part of a complete

application, depending on the applicant’s proposal.

(4) Planning Staff will notify interested agencies of the proposed project to request comments for the application.

(5) Planning Staff will schedule a public hearing before the Cascade County Zoning Board of Adjustment;

(6) Legal notice will be published twice in the Great Falls Tribune with at least six (6) days separating each

publication.

(7) Notice will be sent to all adjacent landowners via certified mail.

(8) Planning Staff will present the application to the Zoning Board of Adjustment along with recommendations,

based on findings of facts.

(9) The Zoning Board of Adjustment will make a determination on the application; three (3) affirmative votes are

needed to issue the permit.

(10) Upon written notice from the Planning Staff, the applicant may begin the permitted special use.

Page 2 of 9

Updated May 14, 2019

(11) Permits may be revoked or expire for the following reasons:

a. The Zoning Board of Adjustment finds them in violation of the conditions of the permit or another

regulation/ordinance.

b. Approval is valid for one particular use and shall expire one year after the date of approval, if

construction or the use has not started. The Zoning Administrator may grant a one-time only 6 month

extension on the Zoning Board of Adjustment Approval.

c. The Special Use Permit shall expire if the use ceases for six (6) months for any reason. Any future

extension requests must be granted by the Zoning Board of Adjustment prior to the date of expiration.

SUP General Impacts Criteria

Explain how the proposed use contributes to, hinders, or otherwise impacts each of the criteria below. All criteria must

be discussed. If criteria are not applicable, please explain why. Attach drawings, additional text, site plans, and any

other documents that will assist staff and the board in reviewing the proposed use. The more information you can

provide, the easier it is for staff and the Zoning Board of Adjustment to review the application.

(1) The proposed development will not materially endanger the public health or safety.

a. Traffic conditions in the vicinity, including the effect of additional traffic on streets and street

intersections, and sight lines at street intersections and approaches:

__________________________________________________________________________________________________

b. Provision of services and utilities, including sewer, water, electrical, telecommunications, garbage

collections, and fire protection:

__________________________________________________________________________________________________

c. Soil erosion, sedimentation, and stormwater run-off:

__________________________________________________________________________________________________

d. Protection of public, community, or private water supplies, including possible adverse effects on surface

waters or ground water:

__________________________________________________________________________________________________

Page 3 of 9

Updated May 14, 2019

(2) The proposed development is a public necessity, or will not substantially impact the value of adjoining property.

a. The relationship of the proposed use and the character of development to surrounding uses and

development, including possible conflicts between them and how these conflicts will be resolved.

__________________________________________________________________________________________________

b. Whether the proposed development is so necessary to the public health, safety, and general welfare of

the community or County as to justify it regardless of its impact on the value of adjoining property.

__________________________________________________________________________________________________

(3) The proposed development will be in harmony with the area in which it is located.

a. The relationship of the proposed use and the character of development to surrounding uses and

development, including possible conflicts between them and how these conflicts will be resolved.

__________________________________________________________________________________________________

b. Consistency with the municipal and joint land use plans incorporated by the Growth Policy.

__________________________________________________________________________________________________

SUP Growth Policy Criteria

Explain how the proposed use will be consistent with each of the Cascade County Growth Policy goal objectives. All

objectives must be discussed. If an objective is not applicable, please explain why. The more information you can

provide, the easier it is for staff and the Zoning Board of Adjustment to review the application.

Goal 1: Sustain and strengthen the economic well-being of Cascade County’s citizens.

Objectives:

A. Stimulate the retention of existing businesses and expansion of existing businesses, new businesses, value-added

businesses, wholesale and retail businesses, and industries including agriculture, mining, manufacturing/processing

and forest products.

__________________________________________________________________________________________________

B. Stabilize and diversify the county’s tax base by encouraging the sustainable use of its natural resources.

Page 4 of 9

Updated May 14, 2019

__________________________________________________________________________________________________

C. Identify and pursue primary business development that complements existing business, which is compatible with

communities, and utilizes available assets. Identify and pursue targeted business development opportunities to

include, but not limited to, manufacturing/heavy industry, telecommunication, and youth/social services.

__________________________________________________________________________________________________

_____________

_____________________________________________________________________________________

__________________________________________________________________________________________________

D. Promote the development of cultural resources and tourism to broaden Cascade County’s economic base.

__________________________________________________________________________________________________

E. Foster and stimulate well-planned entrepreneurship among the county’s citizenry.

__________________________________________________________________________________________________

F. Promote a strong local business environment. Encourage and strengthen business support mechanisms such as

chamber of commerce, development organizations and business roundtable organizations.

__________________________________________________________________________________________________

G. Improve local trade capture for Cascade County businesses. Promote local shopping as well as well-planned

businesses and new businesses.

__________________________________________________________________________________________________

H. Network with and support other economic development efforts in the region and statewide, in recognition of

Cascade County’s interdependence with other communities and to leverage available local resources.

__________________________________________________________________________________________________

I. Encourage the growth of the agricultural economy.

Page 5 of 9

Updated May 14, 2019

__________________________________________________________________________________________________

J. Stimulate the growth of the economy by encouraging the use of alternative methods of energy production, including

wind energy.

__________________________________________________________________________________________________

Goal 2: Protect and maintain Cascade County’s rural character and the community’s historic relationship with natural

resource development.

Objectives:

A. Foster the continuance of agriculture and forestry in recognition of their economic contribution and the intrinsic

natural beauty of grazing areas, farmlands and forests.

__________________________________________________________________________________________________

B. Preserve Cascade County’s scenic beauty and conserve its forests, rangeland and streams, with their abundant

wildlife and good fisheries.

__________________________________________________________________________________________________

C. Preserve Cascade County’s open space setting by encouraging new development to locate near existing towns and

rural settlements and by discouraging poorly designed, land subdivisions and commercial development.

__________________________________________________________________________________________________

D. Assure clean air, clean water, a healthful environment and good community appearance.

__________________________________________________________________________________________________

Page 6 of 9

Updated May 14, 2019

E. Support the development of natural resources including but not limited to timber, mining, oil and gas production

and renewable energy production.

__________________________________________________________________________________________________

F. Continue to work with federal and state agencies to redevelop properties within Cascade County which are currently

undergoing Superfund and Brownfields processes.

__________________________________________________________________________________________________

Goal 3: Maintain agricultural economy.

Objectives:

A. Protect the most productive soil types.

__________________________________________________________________________________________________

B. Continue to protect soils against erosion.

__________________________________________________________________________________________________

C. Protect the floodplain from non-agricultural development.

__________________________________________________________________________________________________

D. Support the development of value-added agricultural industry in Cascade County utilizing the products from the

regional area.

__________________________________________________________________________________________________

Page 7 of 9

Updated May 14, 2019

Goal 4: Retain the presence of the US Military in Cascade County

Objectives:

A. Encourage the federal congressional delegation to actively support maintaining the current mission status at a

minimum.

__________________________________________________________________________________________________

B. Promote the location of additional military missions in Cascade County.

__________________________________________________________________________________________________

C. Encourage the reactivation of the runway at Malmstrom Air Force Base for fixed wing operations.

__________________________________________________________________________________________________

D. Refer to the Joint Land Use Study for resolving conflicts and promoting mission compatible development.

__________________________________________________________________________________________________

Goal 5: Preserve and enhance the rural, friendly and independent lifestyle currently enjoyed by Cascade County’s

citizens.

Objectives:

A. Maintain Cascade County’s citizens independent lifestyle and minimize local governmental intervention, to the

extent possible, consistent with the requirements of a continually evolving economy and constantly changing

population.

__________________________________________________________________________________________________

B. Preserve and promote Cascade County’s rich cultural heritage, rooted in natural resource development and

reflected in its numerous cultural/historic sites and archaeological areas.

__________________________________________________________________________________________________

Page 8 of 9

Updated May 14, 2019

C. Promote fire prevention measures throughout the county, giving special emphasis to the extreme fire hazards

present at the wildland-urban interface.

__________________________________________________________________________________________________

D. Encourage the continued development of educational programs and facilities, recreational opportunities and spaces

and health services for all county residents.

__________________________________________________________________________________________________

ATTEST: I hereby certify that the information given herein is true and correct to the best of my knowledge. There are

no restrictions placed upon my property which would prohibit the issuance of this permit. If there are any restrictions,

then this permit shall become null and void. I hereby grant permission to any Cascade County Zoning Official to enter

my property to inspect for compliance with the County Zoning Regulations in relation to this application.

Printed Name of Applicant: _______________________________________________

Signature of Applicant: ___________________________________________________Date: __________________

Printed Name of Property Owner: __________________________________________

Signature of Property Owner: _____________________________________________Date: ___________________

Page 9 of 9

Updated May 14, 2019

Office Use Only

Fee:

☐

Application ($450.00)

Payment Type:

☐

Check No.: ______________

☐

Cash

Date Application Received: _______________

Application Number: _______________

ZBOA Public Hearing Date: _______________

☐

Completed L/C Application(s)

☐

Completed Use Statement

Date Application Approved: _______________

Associated L/C Permit Number(s): ____________________________

Approved Permit Number: _______________

________________________________________________________

Approved by (staff): _______________

________________________________________________________

Review Items

SUP General Impacts Applicant Response Review

1.a.

☐

Insufficient

☐

Sufficient

2.a.

☐

Insufficient

☐

Sufficient

1.b.

☐

Insufficient

☐

Sufficient

2.b.

☐

Insufficient

☐

Sufficient

1.c.

☐

Insufficient

☐

Sufficient

3.a.

☐

Insufficient

☐

Sufficient

1.d.

☐

Insufficient

☐

Sufficient

3.b.

☐

Insufficient

☐

Sufficient

SUP Growth Policy Criteria Applicant Response Review

Goal 1. A.

☐

Insufficient

☐

Sufficient

Goal 1. B.

☐

Insufficient

☐

Sufficient

Goal 1. C.

☐

Insufficient

☐

Sufficient

Goal 1. D.

☐

Insufficient

☐

Sufficient

Goal 1. E.

☐

Insufficient

☐

Sufficient

Goal 1. F.

☐

Insufficient

☐

Sufficient

Goal 1. G.

☐

Insufficient

☐

Sufficient

Goal 1. H.

☐

Insufficient

☐

Sufficient

Goal 1. I.

☐

Insufficient

☐

Sufficient

Goal 1. J.

☐

Insufficient

☐

Sufficient

Goal 2. A.

☐

Insufficient

☐

Sufficient

Goal 2. B.

☐

Insufficient

☐

Sufficient

Goal 2. C.

☐

Insufficient

☐

Sufficient

Goal 2. D.

☐

Insufficient

☐

Sufficient

Goal 2. E.

☐

Insufficient

☐

Sufficient

Goal 2. F.

☐

Insufficient

☐

Sufficient

Goal 3. A.

☐

Insufficient

☐

Sufficient

Goal 3. B.

☐

Insufficient

☐

Sufficient

Goal 3. C.

☐

Insufficient

☐

Sufficient

Goal 3. D.

☐

Insufficient

☐

Sufficient

Goal 4. A.

☐

Insufficient

☐

Sufficient

Goal 4. B.

☐

Insufficient

☐

Sufficient

Goal 4. C.

☐

Insufficient

☐

Sufficient

Goal 4. D.

☐

Insufficient

☐

Sufficient

Goal 5. A.

☐

Insufficient

☐

Sufficient

Goal 5. B.

☐

Insufficient

☐

Sufficient

Goal 5. C.

☐

Insufficient

☐

Sufficient

Goal 5. D.

☐

Insufficient

☐

Sufficient

Cascade County Use Statement Form

Cascade County Planning Department

121 4

th

St N, Suite 2H-2I

Great Falls, MT 59401

Phone: 406-454-6905 Fax: 406-454-6919

Updated May 14, 2019 Page 1 of 4

Permit No:_____________

App. No.: _____________

Applied Date:__________

The Use Statement Form is required for all Special Use Permit applications and is designed to provide pertinent information

about the proposed use. It is important that the use statement provides a complete understanding of your proposal. The

use statement that you submit must address all the following items that apply to your proposal. Your use statement must

be written in on this form or written in a legible manner on a separate sheet of paper and submitted with your Special Use

Permit application in print or by email. If your responses are written on a separate sheet of paper, indicate the number of

each response corresponding with the item numbers listed below. Where a definite answer cannot be provided for any of

the items below, provide an estimate and indicate any uncertainty. Begin by indicating all relevant uses of the proposal

below and proceed to address each item. The form will not be considered complete without a signed and dated submission

by the landowner and/or applicant.

Use type (check all that apply): ☐ Residential ☐ Commercial ☐ Industrial

If the proposed use is residential only then only questions 1-6 are required. For uses that are commercial and/or

industrial all questions must be addressed. If the item does not pertain to the proposed use, then indicate that the

item does not apply.

1. Nature

of the use - what do you propose to do and how do you plan to do it? Describe in detail.

__________________________________________________________________________________________

2. Acces

s to the site:

☐ Public Road ☐Private Road Surface: ☐ Paved ☐ Gravel ☐ Dirt

Indicate the planned access points in the site plan. If a new approach will be required, contact either Montana

Department of Transportation or County Road and Bridge Division.

3. Describ

e any planned advertising or signage. Include the size, appearance, and placement.

__________________________________________________________________________________________

4. Will existing buildings be used, or will new buildings be constructed (or both)? Indicate new and old

buildings or structures on the required site plan.

__________________________________________________________________________________________

Page 2 of 4

Updated May 14, 2019

5. Will an

y landscaping or fencing be developed? If so, describe the type of landscaping and/or fencing

elements planned. Use reference to the site plan for clarity.

__________________

________________________________________________________________________

__________________________________________________________________________________________

6. Does the pr

oposed use require any other local, state, or federal permits or licensing? If so, indicate the

permits and/or licenses and when they will be acquired. If the permit and/or license has already been

acquired, provide the permit and/or license number.

__________________________________________________________________________________________

If the proposed use is residential only, you may stop here and sign at the end of the form.

7. Operat

ional time limits:

Months (if seasonal): from _______________ to _______________

Days per week: _______________

Hours (HH:MM AM/PM): from _______________ to _______________

Total hours per day: _______________

Special activities: ___________________________________________________________________________

Frequency: _______________

Hours: from _______________ to _______________

Are these indoors or outdoors? _______________

8. Expected number of customers or visitors:

Average per day: _______________

Maximum

per day: _______________

Hours (when they will be there) (HH:MM AM/PM): from _______________ to _______________

9. Number of employees:

Current: _______________

Future: _______________

Hours they work (HH:MM AM/PM): from _______________ to _______________

Do any live on-site as a caretaker? _______________________________________

10. Service and delivery vehicles:

Number: _______________

Type: _______________

Frequency: _______________

Page 3 of 4

Updated May 14, 2019

11. Number

of parking spaces for employees, customers, and service/delivery vehicles:

__________________________________________________________________________________________

12. Are any goods to be sold on-site? If so, are these goods grown or produced on-site or at some other

location? Explain.

__________________________________________________________________________________________

13. What equipment is used? If available, provide pictures or a brochure.

__________________________________________________________________________________________

14. What su

pplies or materials are used and how are they stored?

__________________________________________________________________________________________

15. Does the us

e produce any of the following by-products which may be considered a nuisance?

☐ Noise ☐ Glare ☐ Dust ☐ Odor ☐ Smoke

☐ Other ___________________________________

If so, explain how this will be reduced or eliminated?

__________________________________________________________________________________________

16. Does the p

roposed use involve livestock animals? If so, provide the types of livestock and the

approximate number of each type of animal involved.

__________________________________________________________________________________________

17. Will any solid or liquid wastes be produced (other than septic system waste)? If so, list (for each) : (1) the

type(s) of waste; (2) the estimated volume of waste; (3) how and where it will be stored; (4) how it will be

hauled; (5) where it will be disposed at and how often.

__________________________________________________________________________________________

18. Estimate

d volume of water to be used (gallons per day) and the source of water:

__________________________________________________________________________________________

19. Explai

n which buildings or what portion of buildings will be used in the operation. Use reference to the

indicated structures or buildings in the site plan for clarity.

__________________________________________________________________________________________

20. Will any buildings or portions of buildings be rented or leased? ☐ Yes ☐ No

21. Will an

y outdoor lighting or an outdoor sound amplification system be used? If so, describe how and

when they will be used.

__________________________________________________________________________________________

22. Is there any other information that will provide a clear understanding of the project or operation?

__________________________________________________________________________________________

ATTEST: I hereby certify that the information given herein is true and correct to t

he best of my knowledge and acknowledge

that the information provided herein may be binding upon issuance of an approved Special Use Permit with conditions.

Printed Name of Applicant:____________________________________________________

Signature of Applicant:_______________________________________________________ Date: ___________________

Printed Name of Owner:______________________________________________________

Signature of Owner:_________________________________________________________ Date: ___________________

Updated May 14, 2019

Page 4 of 4

Cascade County Location/Conformance Permit Application

Cascade County Planning Department

121 4

th

St N, Suite 2H/I

Great Falls, MT 59401

Phone: 406-454-6905 | Fax: 406-454-6919

Pa

ge 1 of 3

Permit No: _______________

App. No.: ________________

Applied Date: _____________

Updated 11/16/2020

General Information

A Location/Conformance (L/C) Permit is required: (1) for all changes of land use and commercial activities within Cascade County

jurisdiction and (2) prior to the construction of all buildings and structures two-hundred (200) square feet or larger on all lands within

Cascade County jurisdiction. L/C Permits are not required for “site preparation,” as defined in the Cascade County Zoning Regulations

(CCZR). L/C Permits are to be issued for one use and are required for each tract of land. Legally issued L/C Permits shall expire one

year after the date of approval if construction or the use permitted has not started. A one-time-only twelve (12) month extension may

be granted by the Zoning Administrator upon request. L/C Permit applications require a non-refundable application fee of fifty dollars

($50.00) unless non-site preparation work started prior to the issuance of an L/C Permit; post-work projects require a non-refundable

application fee of two hundred dollars ($200.00).

Project Information

Project Address

☐ Needs an Address

(This is an additional $25 fee)

Estimated Project Value ($)

Property

Description

Legal

Description

Section

To

wnship

Ran

ge

COS

No.

Subdivision

Part, Tract, Block, Lot Descriptors…

Parcel No. Geocode

Total parcel area

Unit: ☐ Acres ☐ Square Feet

Property Owner

Name

Address

Phone Number

Applicant

(Contractor,

Engineer, etc.

that is filling out

this form)

Name

Address

Phone Number

Email

Preferred Method of

Contact

Application

Type

☐

Change of use

☐

New build

☐

Alteration

Previous use:

Use Type

☐ Single-family Residential

☐ Multi-family Residential

☐ Public/NGO

☐ Duplex

☐ Mobile Home

☐ Sign

☐ Commercial

☐ Industrial

☐ Registered Premise

☐ Garage/Shop/Barn

☐ Home Occupation

☐ Other: __________________________

Structures

Number of existing structures Total existing structure area (sq. ft.)

Number of proposed structures Total proposed structure area (sq. ft.)

Total area of alteration (sq. ft.)

Water/Waste

Type of sewage disposal Source of water supply

Page 2 of 3

Updated 11/16/2020

Project Description:

__________________________________________________________________________________________________

Submission Checklist

Location/Conformance Permit Applications shall be submitted to the Cascade County Planning Department for review.

The following checklist must be completed and signed by the Applicant before this Application can be reviewed. All

supporting permits and forms must be attached.

☐ A site plan containing the following information:

☐ A scale not less than one-inch equals one-hundred feet (1” = 100’).

☐ Name and address of the Applicant.

☐ Legal description and boundary lines of property being considered for review.

☐ Existing and proposed land use upon the site.

☐ Names of owners and existing land use on adjacent property.

☐ Location, size, dimensions and uses of existing and proposed buildings and improvements.

☐ Location and description of existing and proposed utilities.

☐ Location and dimensions of curb cuts and access points.

☐ Location, size, dimensions, and number of off-street parking spaces, including on-site vehicular driveways and

type of surface improvements.

☐ Location and type of existing and proposed landscaping or buffering.

☐ Location, type, and height of existing and proposed fencing and screening.

☐ Location, type, and height of sight-obscuring improvement surrounding areas of storage for raw materials,

finished products, machinery, and equipment.

☐ Floodplain Permit (attached). This is required if the project is in a regulated floodplain.

☐ Approach Permit (attached). This is required if the proposed approach is from a county or state road.

☐ Subsurface Wastewater Treatment System Permit (attached). This is required for projects installing a septic system,

re-utilizing a pre-existing septic system, or increasing the capacity of a pre-existing septic system on the subjec

t

property.

☐ General Permit for Small Municipal Separate Storm Sewer Systems (MS4) Permits (attached). This is required for

p

rojects that will disturb an acre or more of land.

Attestation Statement and Signature

I hereby certify that the information given herein is true and correct to the best of my knowledge. There are no restrictions

placed upon my property which would prohibit the issuance of this permit. If there are any restrictions, then this permit

shall become null and void. I hereby grant permission to any Cascade County Zoning Official to enter my property to

inspect for compliance with the County Zoning Regulations in relation to this application.

Signature of Applicant: ___________________________________________________ Date: ______________________

Signature of Property Owner: ______________________________________________ Date: ______________________

Page 3 of 3

Updated 11/16/2020

OFFICE USE ONLY

Fee(s):

☐ Pre-work ($50.00)

☐

Post-work ($200.00)

☐

Addressing ($25.00)

Payment Type:

☐ Check No.: ____________

☐

Cash

Date Application Received: ___________________________

Application Number: _______________________

Reasonable Accommodations Requested & Provided:

☐

Yes

Date Application Approved: ___________________________

Approved by (staff): ________________________

Approved Permit Number: ____________________________

Associated SUP Number: ____________________

REVIEW ITEMS

Zoning District: ___________________________________

Restrictions/Covenants:

☐ Yes ☐ No

☐

N/A

Type: _________________________________________

Physical/Legal Access:

☐

Yes

☐

No

Setback Requirements (ft): Front: ______________ Rear: _______________ Side: ______________

Parking Requirements:

☐ Yes ☐ No ☐ N/A

Existing: ____________ Required: ____________ Proposed: ____________

Landscaping Requirements:

☐ Yes ☐ No ☐ N/A

Frontage Option: _________________ Buffer Option: _____________________

Administrative Relief Requested:

☐ Yes ☐ No

Administrative Relief Granted:

☐ Yes ☐ No

Height Requirements:

☐ Yes ☐ No ☐ N/A

☐ Airport Zone: ____________________ ☐ Military Overlay District: ___________

Floodplain:

☐ Yes ☐ No ☐ N/A

Permit Attached: ___________________

☐ Yes ☐ No

Variance Request:

☐ Yes ☐ No ☐ N/A

Variance Approval Attached: __________

☐ Yes ☐ No

Approach Permit:

☐ Yes ☐ No ☐ N/A

Approach Permit Attached: ___________

☐ Yes ☐ No

City-County Health

Department Approval:

☐ Yes ☐ No

Permit Attached: ____________________

☐ Yes ☐ No

MS4:

☐ Yes ☐ No ☐ N/A

Addressing Approval:

☐ Yes ☐ No ☐ N/A

Addressing Approval Attached: ________

☐ Yes ☐ No

DATA COLLECTION

Permit Category:

☐

Residential

☐

Public/NGO

☐

Commercial

☐

Industrial

Permit Type:

☐

Dwelling Unit(s)

☐ Administrative, Waste Management and

Remediation Services

☐ Agriculture, Forestry,

Hunting or Fishing

☐

Utilities

☐

Manufacturing

☐

Transportation and Warehousing

☐ Arts, Entertainment,

Recreation

☐

Construction

☐

Mining, Quarrying, O & G

☐

Information

☐

Finance and Insurance

☐

Accommodation and Food

Services

☐

Retail Trade

☐

Real Estate and Rental/Leasing

☐

Public Admin.

☐

Prof., Scientific, Tech. Services

☐

Educational Services

☐ Other Services ☐ Health Care and Social Assistance ☐ Wholesale Trade

☐ Other Structures ☐ Signs

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