Fill and Sign the Psc Invoice Form

Application for Development Permit Land Use Bylaw No. 01-99 Municipal District of Foothills No. 31 www.mdfoothills.com 309 Macleod Trail, Box 5605, High River, AB T1V 1M7. Tel: 403-652-2341 Fax: 403-652-7880 This is not a Building Permit. Construction practices and standards of construction of any building or any structure authorized by this Development Permit must be in accordance with the Building Bylaw. An application must be made for a Building Permit under the requirements of the Building Bylaw and a Permit must be secured before any work or construction on any building may commence or proceed. Fee Submitted:___________________________________________ Application No.:_____________________________________ Receipt No.:_ ____________________________________________ Tax Roll No.:________________________________________ Date Received:___________________________________________ part 1 Applicant/agent information Applicant’s Name:_____________________________________________________________________________________ Applicant’s Mailing Address:_____________________________________________________________________________ Telephone:___________________________________________________________________________________________ Legal Land Description: Plan __________________, Block__________, Lot___________, LSD__________, Quarter________, Section________, Township________, Range________, West of the _________ Meridian. Registered Owner of Land:______________________________________________________________________________ Registered Owner Mailing Address:_______________________________________________________________________ _ ___________________________________________________________________________________________________ Telephone:___________________________________________________________________________________________ Interest of Applicant if not owner of site:___________________________________________________________________ _ ___________________________________________________________________________________________________ part 2 Proposed development I/We hereby make application in accordance with the plans and supporting information submitted herewith. (which forms part of this application). Please give a brief description of the proposed development, including name of development where applicable. ____________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ part 3 sITE INFORMATION Area Of Lot: (In Acres Or Hectares)________________________________________________________________________ Size Of Proposed Building: ___________________________________Height:_____________________________________ Is There A Dwelling (Residence) On The Site:______________________ If Yes, How Many?:_________________________ Utilities Presently On Site:_______________________________________________________________________________ Are There Sour Gas Or High Pressure Facilities On Site?:_ ____________________________________________________ Utilities Proposed:_____________________________________________________________________________________ _ ___________________________________________________________________________________________________ Other Land Involved In Application:_______________________________________________________________________ _ ___________________________________________________________________________________________________ Disclaimer: Please note that the personal information collected on this form is authorized under the Municipal Government Act and is required for the purpose of the MD’s Planning and Development processes. This information may also be shared with appropriate government agencies and may also be kept on file by those agencies. The application and related file contents will become available to the public and are subject to the provisions of the Freedom of Information and Protection of Privacy Act (FOIP). If you have any questions about the collection and use of this information, please contact the MD Municipal Planner at 403-652-2341. 03/11 part 4 Development Specify other supporting material attached that forms part of this application. (e.g. Site Plan, Plot Plan, Architectural Drawings, etc.): _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ _ ___________________________________________________________________________________________________ Estimated Date of Estimated Date of Commencement: _______________________________ Completion:____________________________________________ I, ____________________________________________________ hereby certify that I am: c The Registered Owner; or c Authorized to act on behalf of the Registered Owner Date: ________________________________________________ Right of Entry I, being the owner or person in possession of the above described land and any building thereon, hereby consent to an authorized person designated by the MD of Foothills No. 31 to enter upon the land for the purpose of inspection during the processing of this application. _______________________________________ Date ___________________________________________________________ Signature of Owner or Authorized Agent FOR OFFICE USE ONLY 1. Land use district: _ _______________________________________________________________________________________ 2. Listed as a permitted/discretionary use:______________________________________________________________________ 3. Meets setbacks: Yes__________ No__________ If “No”, deficient in_________________________________________ _ ______________________________________________________________________________________________________ _ ______________________________________________________________________________________________________ 4. Other information:________________________________________________________________________________________ _ ______________________________________________________________________________________________________ _ ______________________________________________________________________________________________________ _ ______________________________________________________________________________________________________ part 5 Decision Date of Decision: __________________________________ Date Application Accepted:_ ___________________________ This Development Permit Application is: c approved c APPROVED subject to the attached conditions c REFUSED for the attached reasons Notice of Decision Advertised: ___________________________________________________________________________ Date of Issuance of Development Permit:__________________________________________________________________ ------------------------------------------------------------------------------------------------Development Officer **Important Note: Applications must be received with original signed signature. Photocopies, faxes and emails will not be accepted. Note: Development must commence within 12 months of the date of the Date of Issuance of the Permit and be completed within 24 months of the Date of Issuance, unless otherwise stated in the Development Officer’s decision.