APPLICATION FOR CONCEPT
DIVISION III
TANEY COUNTY PLANNING COMMISSION
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The Concept Application is for the use of the Planning Staff and Commission to
enable us to know the nature of the planned project. The official Division III
Application for permit will be filed along with everything needed to complete your
file, as listed on the Division III Procedure Checklist. Division III Applications:
$100.00, Special Use Applications: $25.00.
~~~YE~~: D_''-'-_1_5_c' _
NAME OF M \t. ~ WI lie k .;:7
APPLICANT: '
(must be oW'fr ~f record)
l
SIGNATUR1 ~~.'-"
DATE: ') 7.5 I () 'b
I (must be owner ofrecord)
MAILING
ADDRESS: ~" i-. L') L..
TELEPHONE Lj(l-)~ ~ OO~S eel( SZ7-;o2. o
NUMBER: -'---, _
NAME OF REPRESENTATIVE: MI bOo W\ ( c k. e
MAIUNGADDRESS(rep.): ~o r- 1--?;,L e<d" 1..0((1 (NO
..
TELEPHONE NUMBER (rep.):
~ <9 '-{ (1 - ~ 3 b - 00 £3 5
..
ACCESS TO PROPERTY (street # and name):
# of Acres (or sg. ft. of lot size):
..
PARCEL #
..
SECTION: TQWNSHIP: RANGE:
\; , 1\ 4') (
NAME OF SUBDIVISION (if applicable):
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Lot # (if applicable) 5 BLOCK #
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WITHIN 600' FROM THIS PROPERTY IS: (check all land uses that apply)
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COMMERCIAL MULTI-FAMILY RESIDENTIAL
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AGRICULTURAL
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MULTI-USE 7 MUNIOPALITY
TYPE OF SEWAGE DISPOSAL SYSTEM:
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CENTRAL TREATMENT PLANT
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PUBUC WATER SUPPLY SYSTEM:
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CENTRAL COMMUNITY WELL
DoES THE PROPERTY UE IN THE 100 YEAR FLOOD PLAIN?(Circle one) /
YES_NO_
THIS REOUEST FALLS INTO ONE OR MORE OF THE FOLLOWING CATEGORIES:
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RESIDENTIAL MULTI-FAMILY COMMERCIAL INDUSTRIAL
OTHER
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Please give a description of your proposed project including all T~r
(IMPORTANT: Make this description as complete as possible as your
pUblic notice will be based on the information provided here.)
DTSC
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