Fill - Free fillable MISCELLANEOUSPLANNINGREQUEST(MSC) Planning&BuildingServicesDepartment PlanningDivision ForOfficeUseOnly FeesPaid Check#CreditCard Cash (Teton County Wyoming Government) PDF form

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MISCELLANEOUSPLANNINGREQUEST(MSC)

Planning&BuildingServicesDepartment

PlanningDivision

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

200S.WillowSt.

P.O.Box1727

Jackson,WY83001

ph:(307)733‐3959

www.tetoncountywy.gov

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MiscellaneousApplication

1 Updated4/15/2019

ForOfficeUseOnly

FeesPaid 

Check#CreditCard  Cash 

Application#

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PROJECT

Name/Description:

PhysicalAddress:

Lot,Subdivision: PIDN:

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OWNER

Name: Phone:

MailingAddress: ZIP:

E‐mail:

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APPLICANT/AGENT

Name: Phone:

MailingAddress: ZIP:

E‐mail:

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DESIGNATEDPRIMARYCONTACT

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 Owner Applicant/Agent

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PURPOSEOFREQUEST

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 PlannerofthedayresearchrequestForinquiriesandresearchrequiringmorethan1hourofstafftime.

 FeeWaiverRequest

 SpecialPurposeFencingExemption

 Reviewofrequiredannualmonitoringreport

 Environmentalanalysisexemptionrequest

 Other

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MiscellaneousApplication 2 Updated4/15/2019

SUBMITTAL REQUIREMENTS Please ensure all submittal requirements are included. The Planning Department will not hold or

processincompleteapplications.

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_______ElectronicSubmittalAcompletedigitalfileoftheapplicationwithattachments/plans.

_______HardCopySubmittalAcompleteprintedfileoftheapplicationwithattachments/plans.

 ApplicationFeeFeesarecumulative.Applicationsformultipletypesofpermits,orformultiplepermitsofthesametype,

requiremultiplefees.SeethecurrentlyadoptedPlanningFeeScheduleonthewebsiteformoreinformation.

 NotarizedLetterofAuthorizationAnotarizedletterofconsentfromthelandownerisrequirediftheapplicantisnotthe

owner.PleaseseetheLetterofAuthorizationtemplateonthewebsiteforasample.

 CorporationsandPartnershipsIftheownerisapartnershiporcorporation,proofthattheownercansignonbehalfofthe

partnershiporcorporation.

 AdditionalSubmittalRequirementsAdditionalinformationrequiredtoreviewaMiscellaneousrequestvariesdepending

onthepurpose.Pleaseattachtheinformationlistedbelow,asapplicable.

PlanneroftheDayResearchRequest

 Includeabriefnarrativedescriptionoftheinquiryorresearchrequested.

FeeWaiverRequest

 ApplicationTypeorNumberIfthefeewaiverisbeingrequestedinadvanceofapplicationsubmittal,indicate

the types of applications involved. If the fee waiver is requested in association withanactive application,

indicatetheprojectnumber.

 Fees to be waived Indicate the amount of the feesto be waived. In the case of a building permit waiver

request,theapplicantshallprovidethebuildingsquarefootageandabasicfloorplanillustration.

 Basis for the fee waiver request See the Fee Waiver Resolution in the adopted Fee Schedule for more

informationonapplicablecriteria.

SpecialPurposeFencingExemption

 ResponsetoSection5.1.2.EoftheLDRsIncludeanarrativestatementaddressingthepurposeofthefencing

andhowitcomplieswiththestandardsfoundinthissection.

 Site Plan Include a site plan of the property, drawn to scale, depicting the location of any existing and

proposedfencing.

 FencingDescriptionDescribeexistingandproposedfencing,includingmaterials,heightanddesign.

ReviewofRequiredAnnualMonitoringReports

 PermitNumberIndicatethepermitorapprovalnumberwithwhichtheannualreportisassociated.

 ReportAttachacopyoftherequiredmonitoringreportorreview.

Environmentalanalysisexemptionrequest

 ExemptionyouarerequestingPleasereference8.2.2.B.1(Pleasenotethatincertaincircumstancesazoning

complianceverificationforenvironmentalstandardsmayberequired).

Other–Brieflydescribethenatureoftherequest:

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Underpenaltyofperjury,IherebycertifythatIhavereadthisapplicationandstatethat,tothebestofmyknowledge,allinformation

submittedinthisrequestistrueandcorrect.Iagreetocomplywithallcountyandstatelawsrelatingtothesubjectmatterofthis

application.

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SignatureofOwnerorApplicant/AuthorizedAgent Date

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NamePrinted Title/Role

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MISCELLANEOUSPLANNINGREQUEST(MSC) Planning&BuildingServicesDepartment PlanningDivision ForOfficeUseOnly FeesPaid CheckCreditCard Cash (Teton County Wyoming Government)

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