2of2(COC)
Assessor’s Parcel No(s):_________________________________________________________
General Plan Land Use Designation: ____________________Zone District:_________________
NOTE TO APPLICANT: Please check each of the following applicable items when
completed and made a part of this application.
One (1) copy of the site plan (24” x 36”) in size, and one (1) (8 ½” x 11”) copy in size
either in hard copy or electronically submitted of the property(s) indicating the following:
Location and boundaries of the property, dimensions of all lot lines, names and location
of all bordering streets and alleys, size and dimensions of all buildings existing and
proposed, parking areas, vehicular access, location of all fences, scale, north arrow and
date.
Copies of present and past Grant Deeds that separately describe or show any lot and tract
numbers of the subject property.
The name, business address, and phone number of the owner, or authorized agent, who
prepared the Certificate of Compliance.
The Zoning Administrator, Building Official, or Town Engineer will consider all aspects of the
Certificate of Compliance before making a determination to approve or deny the request. The
determination of the Zoning Administrator, Building Official, or Town Engineer will be final
unless appealed to the Board of Adjustment in accordance with Section 2.4 of the Town’s
Zoning Ordinance.
APPLICANT’S SIGNATURE AND DATE INDICATES COMPLETION AND
INCORPORATION OF THE ABOVE-MENTIONED ITEMS INTO THIS
CERTIFICATE OF COMPLIANCE APPLICATION.
I certify that I am the record owner or authorized agent, and that the information filed is true and
correct to the best of my knowledge.
_______________________________________ ______________________________
Applicant’s Signature Date
_______________________________________ ______________________________
Owner’s Signature Date
