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(time stamp)
Official Use Only
Conditional Use Permit Application
Conditional Uses are those uses which may have a special impact or uniqueness
demanding closer scrutiny and analysis to the site and the surrounding environment.
When such a use is proposed, a review and report by Planning Division staff of the
location, design, configuration, and impact will be conducted, comparing the proposed
use to fixed standards and presented to the Board of Adjustment for action at a public
hearing. Notices of the request are mailed to all property owners located within 500 feet
of the subject property.
Please complete the entire application, submit with fee and review the standards on page 3.
To:
Polk County Board of Adjustment
1. The undersigned Petitioners request that the Board consider this application for a
Conditional Use Permit for the following use: (Describe briefly the nature of the use.)
_______________________________________________________________________
_______________________________________________________________________
2. Subject Property Address: _________________________________________________
3. Subject Property District and Parcel Number: ________________________________
4. Subject Property Legal Description (attach if necessary):
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
5. Filing Fee: - $413.00
6. Applicant(s) Information:
_________________________________ _________________________________ _________
Applicant (Print Name) Signature Date
_____________________________________________ _________________________________
Interest in Property (owner, renter, perspective buyer, etc.) Email
_______________________________________________________ _______________ _______________
Address, City, State and Zip Phone Fax
7. Applicant(s) Representative:
If the appeal is going to be represented by someone other than the applicant please provide that information below.
________________________________ __________________________________________________
Applicant Representative (Print Name) Firm or Business Name
________________________________________________________________
Address, City, State and Zip
________________________________________________ ________________ _________________
Email Phone Fax
8. Property Owner Consent:
The application must be signed by all the Titleholders, Contract Purchasers, or Option Purchasers of the subject
property. The application may also be signed by the Registered Agent for a corporation or other person with similar legal
authority to sign for a property owner. (if additional signatures are needed please attach)
_________________________________ _________________________________ _________
(Print Name) Signature Date
_________________________________ _________________________________ _________
(Print Name) Signature Date
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signature
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signature
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9. Written description:
Please prov
ide a written description providing specific detail and reasons for the proposed Conditional Use Permit. (attach if
necessary)
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10. Required Information: (must be included prior to making submittal)
A. Complete Application including the detailed description of requested Conditional Use Permit, including
specific information about the request.
B. Submit six (6) copies of a fully dimensioned, to scale site plan meeting site plan requirements, as required.
1. Provide additional information as required by Zoning Ordinance specific to the use requested.
2.
Submit a reduced size, 11”X17” site plan that is legible that can be reproduced.
A completed application with required information and filing fee must be submitted.
Incomplete submittals will not be processed and will be returned to the Applicant.
Return forms to: Polk County Public Works, Planning & Development Division 5885 NE 14
th
Street
Des Moines, IA 50313
Phone (515) 286-3705 Fax (515) 286-3437
Forms available online http://www.polkcountyiowa.gov/PublicWorks/
OFFICIAL USE ONLY
Received by Docket Number
Application deadline Date Received
BOA meeting date BOA Approved Y / N
BOA Calendar Calendar
email: PublicWork
s@polkcountyiowa.gov
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Conditional Use Permit Standards
Section 1. Review Standards
The review determines whether the proposed use should be permitted by weighing public need for and benefits
to be derived from the use against the local impact which it may cause. The review shall consider the proposal
in terms of:
(A) Existing zoning and land use in the vicinity of the use; and
(B) planned and proposed public and private developments which may be adversely affected by the proposed
use; and
(C) whether and to what extent the proposed use, at the particular location for which it is suggested, is
necessary or desirable to provide a development which is in the interest of the public or which will
contribute to the general welfare of the area or Polk County; and
(D) whether and to what extent all steps possible have been taken by the developer to minimize any adverse
effects of the proposed use on the immediate vicinity and on the public health, safety and welfare in
general.
Section 2. General Standards
No application for a conditional use permit shall be approved unless the Board of Adjustment specifically finds
the proposed conditional use appropriate in the location for which it is proposed. This finding shall be based on
the following criteria:
The proposed use shall be in harmony with the general purpose, goals, objectives, and standards of the Polk
County Comprehensive Plan, this Ordinance, or any other plan, program, map, or ordinance adopted, or under
consideration pursuant to official notice, by the County.
(A) The proposed location and use shall be consistent with policies or provisions of the Comprehensive Plan,
this Ordinance, or other plans or programs of the County.
(B) The proposed use at the proposed location shall not result in a substantial or undue adverse effect on
adjacent property, the character of the neighborhood, traffic conditions, parking, public improvements,
public sites or rights-of-way, or other matters affecting the public health, safety, and general welfare, either
as they now exist or as they may in the future be developed as a result of the implementation of provisions
and policies of the Comprehensive Plan, this Ordinance, or any other plan, program, map, or
ordinance
adopted, or under consideration pursuant to official notice, by the County or other governmental agency
having jurisdiction to guide growth and development.
(C) The proposed use in the proposed area will be adequately served by, and will not impose an undue burden
on, any public improvements, facilities, utilities, and services. Where any such improvements, facilities,
utilities, or services are not available or adequate to service the proposed use in the proposed location, the
applicant shall, as part of the application and a condition to approval of the proposed conditional use
permit, be responsible for establishing ability, willingness, and binding commitment to provide such
improvements, facilities, utilities, and services in sufficient time, and in a manner consistent with the
Comprehensive Plan, this Ordinance, and other plans, programs, maps, and ordinances adopted by Polk
County to service the development. The approval of the conditional use permit shall be conditioned upon
such improvements, facilities, utilities, and services being provided and guaranteed by the applicant.