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Thomas B. Quaw Square ▪ 91 E. Central ▪ Belgrade, MT 59714 Phone: (406) 388-3760 ▪ Fax: (406) 388-4996 Belgrade City-County Planning Office APPLICATION FOR CONDITIONAL USE PERMIT 1. Name of Property Owner: 2. Name of Applicant: 3. Address of Applicant: 4. Phone # and/or email address of Applicant: 5. Legal description of subject property: 6. Address of project: 7. Current Zoning: Land Area: 8. Conditional Use Permit request is for the following: (Use additional pages if necessary or provide separate documentation) In addition to a detailed narrative explaining the proposed project, submit project plans, diagrams, and a site plan on paper not larger than 11”x17”, a a list of names and mailing addresses of all property owners within 300 ft of the subject property, and a $760 filing fee to the City of Belgrade. The application will not be considered until all required information is submitted. I hereby certify that the above information is true and correct and that I am the Owner’s of the above described property. Applicant’s Signature For office use only Date Filing P.Board Hearing: Action City Council Hearing: Action taken: