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Conditional Use Permit Application Revised 7/7/2016 Page 1 Application for Conditional Use Permit 101 N. 4th Street / P. O. Box 1030 Douglas, Wyoming 82633 [PHONE REDACTED], Fax: [PHONE REDACTED] Date of Application: Fee: $75.00 Applicant Name: Email: Applicant Address: Home Phone: Business Phone: If the applicant is other than the owner of the property for which this conditional use permit is being sought, the applicant must provide separate written approval from the owner or the owner may indicate approval by signing below. Property Owner (as on deed) Signature Mailing Address Telephone No. City State Zip Code Email Date Proof of ownership must be provided. Legal Description of Property proposed for Conditional Use: Street Address of Proposed Property: Current Zoning: Current Use of Property proposed for Conditional Use: Proposed use of Property: (For animals, please include: type, number, and use of animals, i.e., pet, grazing, breeding, other; square footage of property; plot plan indicating location and size of all buildings, including animal shelter, and fencing; and information relating to the type of shelter provided. For other uses, please include: the size of building number of occupants and/or employees; hours of operation; and a plot plan of the property showing location of buildings, off-street parking spaces, routes of ingress/egress, and fencing/screening.) Planning Department Comments: Code Compliance Officer Comments: State of Wyoming: Fire Prevention & Electrical Safety (if applicable) Yes No Staff Recommendation: Planning Commission: Approval Denial City Council: Approval Denial Date: Date: Date License Issued by Planning Department: For Office Use Only Date Payment Received: Receipt No.: SIGN