Fillable Home Occupation Permit Application (Polk County)

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Home Occupation Permit Application (Polk County)

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The Home Occupation Permit Application (Polk County) form is 2 pages long and contains:

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U.S.A. forms for Polk County

BROWSE POLK COUNTY (IA) FORMS

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Page 1 of 2
(time stamp)
Official Use Only
Home Occupation Permit Application
All home occupations require a permit. The home occupation must be clearly
subordinate to the residential use of the property. Please complete the entire
application, sign and have the Statement of Understanding notarized. A completed
application with diagram of dwelling or garage and filing fee are all required for a
submittal.
1. Applicant Information
__________________________ _______________________________ _________
Applicant (Print Name) Signature Date
_____________________________________________
Interest in Property (owner, renter, perspective buyer, etc.)
____________________________________ ________________ _______________
Email Phone Fax
_____________________________________________________
Address, City, State and Zip
2. Subject Property Address: ___________________________________
3. Subject Property Zoning District: ________________________________
4. Subject Property Legal Description (attach if necessary)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
5. Proposed Use for Home Occupation: ___________________________________________________________
6. Business Name: ___________________________________________________
7. Total Square Footage of House _____________ 8. Square Footage to be used for business ________________
9. Proposed Number of parking spaces________________ 10. Estimated number of customers per day: _______
11. Provide Specific Detailed Description of Business Activity: (must be completed, attach if necessary)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
12. Required Documentation (include with submittal of application)
• Diagram of Dwelling unit or garage including floor plan showing the area devoted to the home occupation.
13. Filing Fee: $87.00
14. Site Inspection: A site inspection of your property will be conducted as part of the application process. The
property will be inspected for compliance with the Home Occupation Permit Application. The property must be in
compliance with Polk County Ordinances at the time of inspection for the permit to be issued.
OFFICIAL USE ONLY
Date Received: Received by:
Floodplain - Map #
Flood Zone
Site Inspection Date:
Site Inspection by:
Date Issued: Is
sued by:
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Page 2 of 2
Home Occupation Permit Application
Statement of Understanding
All home occupations must meet all of the following criteria:
(1) The business shall be conducted by a resident of the dwelling. No employees
are allowed for a home occupation, other than immediate family members who
reside in the dwelling.
(2) The use of the dwelling for a home occupation shall in no way destroy or be incompatible with the
residential character of the neighborhood.
(3) No more than one (1) home occupation shall be carried on a parcel of land.
(4) No odor, noise, vibration, dust and electrical interference shall be detectable at the property line.
(5) The residence shall not be used as a storage facility for a business conducted elsewhere.
(6) Automobile dealers and other retail uses that require outdoor display are not permitted as a home
occupation.
(7) The following additional standards are required for all home occupations except for child care homes:
(a) The home occupation may be conducted inside the dwelling or accessory building.
(b) No more than twenty (20) percent of the total floor area of the dwelling shall be used for the home
occupation. The total floor area shall include total square footage of the house excluding any
attached garage or accessory building.
(c) No activity, materials, goods or equipment incidental to the home occupation shall be stored
outdoors.
(d) The home occupation shall not significantly increase the traffic in the area.
(e) The home occupation shall be limited to two (2) customers at one time. Parking shall be so
designed and constructed to be visible similar to residential property and driveways in the area.
Acknowledgement:
By signing below I hereby acknowledge that as the property owner, I have read the above listed regulations,
understand them and will operate my home occupation in accordance with them.
I also understand that any violation of any of the above provisions or stated business practices within my detailed
description of business activity on the Home Occupation Permit Application will be an immediate revocation of my
Home Occupation Permit. Violation(s) constituting revocation of the Home Occupation Permit allow immediate
abatement of the violation(s) by Polk County.
Signature:__________________________________________ Date:____________________
Print Name:_________________________________________
STATE OF IOWA )
)SS
COUNTY OF POLK )
Subscribed and sworn to before me this ________ day of ______________________, 20___.
_________________________________________________
Notary Public in and for said State of Iowa
A completed application with required documentation 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 ▪ Email: PublicWorks@polkcountyiowa.gov
Forms available online http://www.polkcountyiowa.gov/PublicWorks/
(Plea
se allow 7 -10 days for processing)
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Home Occupation Permit Application (Polk County)

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Completed 14 February 2021

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