Description of Zoning Resolution Amendment: (attach additional sheets if necessary)

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1 CARBON COUNTY Department of Planning and Development 215 West Buffalo, Suite 336 Application Fee $ (plus public notice cost) Rawlins, WY Fee Paid $ Date Tel (307) FAX (307) Case File No. Z.C. CASE # APPLICATION FOR A ZONE CHANGE OR AMENDMENT OF ZONING RESOLUTION TEXT AMENDMENT (To be completed by applicant) Applicant: Date: Phone: Address: Owners (if not Applicant): Date: Phone: Address: Description of Zoning Resolution Amendment: (attach additional sheets if necessary) LEGAL DESCRIPTION OF THE PROPERTY(S): (attach additional sheets if necessary) GEO/Parcel Identification Number(s) (PIN) #: Quarter Sections Section Township Range Subdivision Name Block Lots Site Address or Location: Lot or Parcel Size: Existing Zoning: Proposed Zoning: Please indicate at least one (1) of the following reasons for the zone change and attach an explanation or justification for the request: Is necessary to come into compliance with the Zoning Resolution; The existing zoning of the land was the result of a clerical error; The existing zoning of the land was based on a mistake of fact; The existing zoning of the land failed to take into account the constraints of the affected property due to natural characteristics of the land, including but not limited to, steep slopes, floodplain, unstable soils, and inadequate drainage; The affected property or its surrounding environs has changed or is changing to such a degree that it is in the public interest to encourage a redevelopment of the area or to recognize the changed character of the area; or The proposed rezoning is necessary in order to provide land for a community need that was not anticipated at the time of adoption of the Zoning Resolution. The application will not be processed until it is accepted as complete. The applicant is solely responsible for submitting a complete application and any delays that result from inaccuracies or an incomplete application. Page -1-

2 Please attach the following required information: 1. Application fee (see Current Fee Schedule). In addition, the applicant will receive an invoice for the actual cost of public notice. Applicant is responsible for recording resolution fee(s). 2. Proof of ownership: a. Warranty Deed, Title Policy, or Contract for Deed, and b. Signed authorization letter from the owner if other than applicant. 3. A written legal description of all property that is subject to this application. The legal description must contain the seal of a professional land surveyor, registered in the State of Wyoming. The applicant must provide the legal description in Word format for advertising/publication purposes. 4. A Statement demonstrating that the proposed Zone Change Request is generally consistent with the Goals, Strategies and Actions of the Comprehensive Land Use Plan, including the Future Land Use Map. In addition, the staff will provide a summary at the Planning & Zoning Commission meeting. 5. Site Plan and Vicinity Map. 6. Statement of purpose and need. 7. Ingress and egress shall be provided to each parcel by a binding and recordable easements of not less than forty (40) feet in width to a public road unless specifically waived by the Board. 8. Tax Certificate must be signed by the Carbon County Treasurer or authorized deputy. 9. Provide copies of the County Assessor s current Notice(s) of Assessment for the subject property(s). 10. Provide a completed affidavit (attached) that must accompany the mailing labels, attesting that the submittal includes true and accurate listing of the adjacent/abutting property owners as reflected in the records of the Carbon County Assessor s Office. 11. Provide one (1) set of self-adhesive mailing labels containing the addresses of all adjacent/abutting property owners. The labels are used to provide mailed notice of the application to all adjacent/abutting property owners. 12. The applicant shall post a sign on the approach to the subject property not less than fourteen (14) days prior to the Planning & Zoning Commission meeting date. The Planning Department will provide the applicant a sign and approve the posting location. The Applicant/Owner should provide digital photos of the posted sign with date and time stamps and submit the photos to the Planning Department. OPTIONAL INFORMATION THAT MAY EXPEDITE REVIEW. This information is typically required for subdivision and building permit applications. 1. Wyoming Dept. of Environmental Quality: Septic/Wastewater Permit(s)-application submitted? Yes No Pending Permit # Date Issued: 2. Wyoming State Engineer s Office: Well water permit(s)-application submitted? Yes No Existing Permit # Date Issued: 3. Survey Map must contain the seal of a professional land surveyor, registered in the State of Wyoming. I do hereby certify that the foregoing representation and attachments are true and correct to the best of my knowledge. PRINTED SIGNATURE-landowner SIGNATURE-landowner DATE PRINTED SIGNATURE-applicant SIGNATURE-applicant DATE Form Revised: January 17, 2018 Page -2-

3 AFFIDAVIT Attesting to the Accuracy of Information Provided to Carbon County, Wyoming In Carbon County, Wyoming, (Applicant or Authorize Representative Please Print) has made application to Carbon County that requires notice to abutting\adjacent property owners, and being duly sworn, deposes and says that the mailing labels of abutting\adjacent property owners (land having a common property line or separated only by an alley, easement or private road) submitted with their application, is a true and accurate listing of those property owners, as reflected in the records of the Carbon County Assessor s office on, 20. The Applicant does hereby accept responsibility for any inaccuracies in the production of these mailing labels of abutting\adjacent property owners that result from applicant s errors, rather than errors in the Assessor s records, and holds harmless Carbon County for any delays in processing of the applicant s petition that result from these inaccuracies., (Applicant or Authorize Representative Signature) I,, a Notary Public of the (COUNTY), (STATE) aforesaid, hereby certify that personally known to me to be the affiant in the foregoing affidavit, personally appeared before me this day and having been by me duly sworn deposes and says that the facts set forth in the above affidavit are true and correct. Witness my hand and official seal this the day of, 20. (SEAL) Notary Public My Commission expires: / /. Date Revised: June 25, 2012

4 Adjacent Property Owners Example: Bureau of Land Management Attn: Realty Division PO Box 2407 City: Rawlins State: WY Zip: 82301

5 TAX CERTIFICATE STATE OF WYOMING ) ) SS. COUNTY OF CARBON ) I, PATTY BENTSEN, TREASURER OF CARBON COUNTY, WITHIN AND FOR THE COUNTY OF CARBON, STATE OF WYOMING, DO HEREBY CERTIFY, I HAVE EXAMINED THE RECORDS OF THIS OFFICE AND FROM SUCH EXAMINATION DO FIND THE TAXES UPON: OWNER NAME: PROPERTY DESCRIPTION: ASSESSOR S ACCOUNT NO.: PROPERTY TAX ID: PIN (14 DIGITS): TAXES DUE AS FOLLOWS FOR THE YEAR: 1 ST HALF 2 ND HALF TOTAL PAID UNPAID DATED AT RAWLINS, WYOMING, ON THIS DAY OF, 20. PATTY BENTSEN, TREASURER OR AUTHORIZED DEPUTY

6 CARBON COUNTY PLANNING AND DEVELOPMENT TEL (307) FAX (307) FEE SCHEDULE Please make checks payable to Carbon County Planning. Application Fee and Subdivision Permit Fees must be paid at the time the application is submitted and is not refundable. The newspaper(s) will bill the applicant directly for Public Notice charges. APPLICATION TYPES: FEES: Plus the cost of public notice. Conditional Use Permit (Minor) $ Conditional Use Permit (Major) See Page 2 Conditional Use Permit Transfers $ Zone Change $ Planned Unit Development ZC $ Planned Unit Development SUB Application fees in accordance with the Subdivision Subdivision Application/Filing Fees: Minor Subdivision Major Subdivision: Sketch Plan Preliminary Plat Application/Filing Fees below. Due upon submittal of the Application. $ (Final Plat) $ $ $100 per lot, up to $1, $ Final Plat Subdivision Permit Fee The greater of $ or $10.00 per lot up to $1, Variance $ Sign, Floodplain and Solar Access $60.00 BUILDING PERMIT APPLICATION, INCLUDES ZONING CERTIFICATES: *VALUE OF IMPROVEMENTS OR REPLACEMENT COST NEW: APPLICATION FEE: $0.00 TO $5, $25.00 $5, TO $20, $75.00 $20, TO $100, $ $100, TO $200, $ $200, TO $300, $ $300, TO $400, $ $400, TO $500, $ $500, TO $600, $ $600, TO $700, $ $700, TO $800, $ $800, TO $900, $ $900, TO $1,000, $ $1,000, and over $1, Non-Commercial Wind Energy Generators, in accordance with above. *The cost including material and labor that will be incurred in constructing the improvement. Includes hired or contract labor but does not include owner/builder labor.

7 Number of Project Structures- Wind Turbines: OTHER BUILDING PERMIT APPLICATION FEES: Commercial Wind Energy Facilities - Each Wind Turbine - $ Re-tooling\Reconstruction of Existing Facilities - Each Wind Turbine - $ Transmission Line Towers or Poles - Each Tower or Pole - $ Telecommunication and MET Towers - Each Tower or Pole - $ Major Conditional Use Permit Applications: Commercial Wind Energy Facilities Transmission Lines over 115,000KV Application Fee: $100.00** Plus Number of Project Structures- Transmission Towers or Poles: Application Fee: $100.00** Plus $3, $3, $4, $4, $5, $5, $7, $7, $9, $9, and over $10, and over $10, Not to exceed $10, **Plus the actual cost of public notice charges. PUBLICATIONS: available on-line: Free Carbon County Zoning Resolution $25.00* Carbon County Subdivision Regulations $25.00* Carbon County Land Use Plan $50.00* *=Plus applicable postage charges. GIS Data and Maps: Custom Maps: $31.00 per hour (1 hour minimum) Parcel Data Shapefile: $ (entire County) Parcel Data Update: $ Other GIS Data: $20.00 per shapefile Road Data: $ Address Points: $25.00 Employee time for assistance with preparing a complete application may be charged as per Resolution for professional time 1 hour minimum. Date Adopted: January 16, 2018 Page -2-

APPLICATION FOR A BUILDING PERMIT (To be completed by applicant) (Please Print or Type)

APPLICATION FOR A BUILDING PERMIT (To be completed by applicant) (Please Print or Type) CARBON COUNTY Department of Planning and Development Application Fee $: 215 West Buffalo, Suite 336 Check #: Rawlins, WY 82301 Receipt #: Tel (307) 328-2651 FAX (307) 328-2735 Permit #: Date Issued: www.carbonwy.com

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