FILE NAME: FILE NO.
PRELIMINARY ZONE CLEARANCE REQUEST
Utah County Community Development C Planning Division
51 South University Avenue, Suite 117, Provo, Utah 84601
Telephone: (801) 851-8343 C Facsimile: (801) 851-8340
Tax Serial Number ___________________________________________
Applicant’s Name ________________________________________________________________________________________
Applicant’s Mailing Address_______________________________________City _______________St_________Zip _________
Home Phone _______________________ Cell Phone _________________________ Fax _______________________________
Email ___________________________________________________________________________________________________
Specific type of structure or land use requested: _________________________________________________________________
_______________________________________________________________________________________________________
Applicant’s Certification: I certify that the information I have provided is true and accurate. Should preliminary zoning approval be
granted, I understand that any permits for a building or use issued on the basis of this clearance authorizes only the use, arrangement,
and construction set forth herein, and only in accordance with applicable state and county regulations. I acknowledge that any appeal
to this decision must be made in accordance with the requirements found in Section 7-18, Utah County Land Use Ordinance, which
include, but are not limited to, a written claim of error within 20 days, and an application for appeal within 45 days.
______________________________ __
Applicant’s Signature
STAFF USE ONLY
Section Township Range Subdivision Lot
Zone Overlay Zone/Covenant Area Public Road Frontage
Yes No
Property Address
App. Fee: $30.00
Receipt No.
Date Rec’d
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