Form Center

2. First Name *
3. Last Name*
4. Mailing Address*
6. Email Address*
7. Phone Number
9. First Name*
10. Last Name*
11. Mail Addresss*
13. Email Address*
14. Phone Number
16. Street Address*
17. Legal Description*
    Please include Subdivision Lot and Block # or Township Range Section
18. Parcel Number
20. Please give a brief description of what the project is about*
21. Is the applicant the owner of the property legally described above?

    1. yes
    2. no
22. If not, please explain
24. Does the applicant own property adjacent to the area proposed for development?

    1. yes
    2. no
25. If yes, please explain
26. Present Land Use
28. Please attach the following items
    a) Septic permit and letter from the South Central Health District. following: b) Proof of ownership. c) Vicinity map which includes all lands within ½ mile of subject property. d) Lot and parcel map available from the County Assessor's Office which shows at a minimum parcels or lots within 300' of the exterior boundary of the subject property. The applicant is responsible for accurately indicating the names of surrounding landowners, including private road owners, on the map. e) The names and addresses of surrounding landowners within 300' of the exterior boundary of the subject property, including private road owners, are to be typed onto self-adhesive copier labels. f) Three (3) sets of plans when application requires Hearing Examiner or administrative approval, drawn to scale showing surface view (plan view) of elevations or contours of the ground; pertinent structure, fill or storage elevations; size, location and spatial arrangement of all proposed and existing structures on the site; the IRF and floodway boundaries as taken from the Flood Insurance Rate Maps, existing and proposed easements, location and elevations of streets, water supply, sanitary facilities; - Site specific information from the studies listed in §9 17 1D of Zoning Ordinance, including IRF elevation at the building site, location of the boundary of the IRF, ordinary high water mark and riparian setback area; - A profile thru the building site showing the slope of the bottom of the channel or flow line of the stream, proposed areas of fill, natural ground contours and overflow channels and the elevation of the bottom of floor joist and finished floor of the proposed construction relative to the IRF elevation; - Photographs showing the existing land uses and vegetation upstream and downstream and soil types. -Specifications for building construction and materials, flood proofing, filling, dredging, grading, channel improvement, storage of materials, water supply and sanitary facilities - Existing direction of water forces, areas of critical erosion, potential for channel movement or relocation and related hydraulic considerations; - Groundwater table level at high water in the spring. - Exterior building elevations and floor plans for proposed structure(s); - Location of utilities including electric, gas, well, septic tank and drain field(s); g) Typed responses to attached Standards of Evaluation h) Agency review of the proposal as determined appropriate by staff; I) * A refundable “Notice” fee of $50.00 for a Notice board to be posted on site of property being considered for at least 7 days prior to public hearing. j) * Application fee of $600.00 and current postage + .15¢ per surrounding land owner mailing fee. k) There may be County Engineer review fees in addition to application fee. l) When the proposed use involves a potential contaminant source or potential contaminant as set forth in appendix A of this title on file in the county, and is located within a wellhead protection area, written comment from Idaho Department of Environmental Quality and from any other appropriate agency, including, but not limited to, owners of public water systems located within the wellhead protection area, shall be solicited if this is determined by the administrator to be necessary. m) A written statement by a licensed engineer that the project will have no adverse impact or that such impacts have been identified and mitigated to the maximum extent feasible.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field