Utah County Zoning Compliance Permit Application
51 S University Ave, Suite 117, Provo UT 84601 (801) 851-8342
Property Owner’s Name ______________________________________ Application Date _________________
Owner’s Mailing Address ____________________________ City _____________ State ______ Zip ________
Contact/Applicant Name __________________________ Phone _____________ Email __________________
Contact/Applicant Mailing Address __________________________ City ________ State ______ Zip _______
Approximate Job Site Address/Location _________________________________________________________
List Any Existing Structures & Uses on Property __________________________________________________
Job Site Tax Serial # _________________________________________________ Lot Size (acres) _____________
Use of Propane____ Diesel Fuel____ Other Hazardous Materials____ Distance to the nearest fire hydrant _________
Description of Work _________________________________________________________________________________
__________________________________________________________________________________________________
Attach a detailed site plan and/or other plans, as required, of the property, existing structures and locations of the desired
uses and structures.
Health Department Approval Must be completed prior to application submittal. The above applicant agrees to comply with
Utah County Health Department and Utah State regulations for the installation and/or connection to the required potable water and
waste water facilities, when applicable for the proposed work.
Wastewater Approval _________________ Date ______________ or Public System ________________ Date _______________
Potable Water Quality Approval _____________ Date ____________ ...or Public System __________________ Date ____________
Water Source Protection yes/no ______________________
APPROVED: __________________________________________________________, Utah County Health Department
Public Works Engineering Division Approval Must be completed prior to application submittal unless not required.
Review and conditions:
APPROVED: _____________________________________________________________, Utah County Public Works
APPLICANT: PLEASE READ CAREFULLY
I agree to comply with all County and State Building, Fire and Zoning laws and ordinances, and that the representations in this application for a
Zoning Compliance permit are true and accurate, and any misrepresentations or errors herein are the sole responsibility of the applicant, and shall in
no way incur or accrue the liability or obligation to enforcing officers or agents.
This permit becomes null and void if work on construction authorized is not commenced within 180 days, or if no inspections
are performed for a period of 180 days, or if construction or work is suspended or abandoned for a period of 180 days at any
time after work is commenced.
USE OR OCCUPANCY OF A USE OR STRUCTURE IS PROHIBITED UNTIL PERMIT RECEIVES FINAL APPROVAL
WHICH INCLUDES ANY APPLICABLE INSPECTIONS
Owner’s or Applicant’s Signature ______________________________________________ Date __________________
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Utah County Zoning Compliance Permit Applications
Requiring Health Department Review and Approval
*Does the proposed use include utilization of a potable water supply facility or a sanitary
sewage disposal facility?
Applicable Rule; (Utah Code, Utah County Land Use Ordinance, Adopted Health Codes)
Yes or No
*Is the proposed use within 5’ of an existing septic tank or drain field area?
Applicable Rule; (Utah Code
R317-4-13 Table 2)
Yes or No
*Is the proposed use located on a parcel of land that has an existing private wastewater
system? If yes, does the proposed use interfere with an onsite private wastewater system area
or a designated replacement area for such system?
Applicable Rule; (Utah Code R317-4-3 Sections 3.8)
Yes or No
(If unknown, please consult with the Health Department for help in answering this question.)
*Does the proposed use include a pollution source within a drinking water source protection
zone?
Applicable Rule; ( Utah Code and Utah County Code Article 10-8)
Yes or No
(If unknown, please consult with the Health Department for help in answering this question.)
*Does the proposed use include the preparation of food for consumption by the public or
patrons?
Applicable Rule; ( Utah County Code Article 10-4)
Yes or No
If yes is answered to any of the above questions, Health Department review and
approval is required on the Building Permit Application prior to application
submittal.
Applicants signature___________________________________
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signature
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