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. Na
ture of the use - what do you propose to do and how do you plan to do it? Describe in detail.
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2. Ac
cess 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. Desc
ribe any planned advertising or signage. Include the size, appearance, and placement.
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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.
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Page 2 of 4
Updated May 14, 2019
5. Will
any 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.
____________
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6. Does th
e proposed 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.
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If the proposed use is residential only, you may stop here and sign at the end of the form.
7. Oper
ational 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: _______________
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Updated May 14, 2019
11. Num
ber of parking spaces for employees, customers, and service/delivery vehicles:
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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.
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13. What equipment is used? If available, provide pictures or a brochure.
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14. Wha
t supplies or materials are used and how are they stored?
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15. Does t
he use 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?
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16. Does t
he proposed use involve livestock animals? If so, provide the types of livestock and the
approximate number of each type of animal involved.
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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.
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18. Esti
mated volume of water to be used (gallons per day) and the source of water:
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19. Exp
lain 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.
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20. Will any buildings or portions of buildings be rented or leased? Yes No
21. Wil
l any outdoor lighting or an outdoor sound amplification system be used? If so, describe how and
when they will be used.
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22. Is there any other information that will provide a clear understanding of the project or operation?
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ATTEST: I hereby certify that the
information given herein is true and correct to the 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:____________________________________________________ Date: ___________________
Signature of Applicant:_______________________________________________________ Date: ___________________
Printed Name of Owner:______________________________________________________ Date: ___________________
Signature of Owner:_________________________________________________________ Date: ___________________
Updated May 14, 2019
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