Parcel Permit Application

PARCEL PERMIT APPLICATION

Application Information

Application Number:    Date Submitted:

Phone:    Email:    Contact Role:

Property Information

Assessor Parcel Number (APN):    Zoning Designation:    General Plan Land Use:

Project Description and Proposed Action

Type of Permit Requested: Parcel Map Lot Line Adjustment Boundary Adjustment Other:

Number of Parcels Proposed:    Proposed Parcel Sizes:

Requested Tentative Approval Date:    Requested Final Approval Date:

Utilities, Access, and Improvements

Attachments Checklist (Check all that apply)

Site plan / vicinity map

Recorded legal description / deed

Current survey / parcel map

Soils / geotechnical report

Drainage / grading plan

Preliminary title report

Environmental and Hazard Disclosures

Is the site within a designated floodplain? Yes No

Are there known wetlands or streams on the parcel? Yes No

Known contaminated soils or underground tanks? Yes No

Fees and Payment

Application Fee: $    Deposit for Consultants: $

Payment Method:    Fee Non-Refundable:

Administrative Terms, Certifications, and Conditions

By signing this application the applicant certifies under penalty of perjury that the information contained herein and the accompanying documents are true and correct to the best of the applicant's knowledge. Submission of this application authorizes authorized representatives to enter the property at reasonable times to conduct inspections related to the processing of this permit.

The applicant acknowledges that acceptance of this application does not constitute approval of the proposed action. The applicant agrees to comply with all applicable statutes, ordinances, rules and regulations and to furnish any additional information necessary for processing. Applicant agrees to indemnify and hold harmless the municipal entity and its officers and employees from and against any claims arising from the preparation, review, approval, or denial of this permit, except where caused by the gross negligence or willful misconduct of the municipality.

Expiration: Unless otherwise provided, approvals granted based on this application shall expire if substantial progress towards required improvements is not commenced within the time prescribed by the approving authority. Appeals: any appeal of a determination made pursuant to this application must be filed in writing within the time established by local administrative rules.

Governing Law: This application and any approvals issued hereunder are governed by the laws and ordinances of the jurisdiction in which the subject property is located. This instrument represents the entire understanding between the applicant and the municipality with respect to processing of the parcel permit and supersedes all prior communications.

Acknowledgment of Ownership Consent (If applicant is not owner)

Certification

I certify that I am the applicant or the authorized agent of the applicant and that I have the authority to submit this application. I understand that any false statement made herein may subject me to penalties under applicable law. I agree to receive notices at the contact information provided above and to respond to requests for additional information in a timely manner.

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