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Planning & Zoning Department Planning & Zoning Department Planning & Zoning Department Planning & Zoning Department 152 East Ave A, Jerome, ID 83338 Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] Temporary RV Residence Permit Application New Application Renewal I. Applicant Information Applicant Name: Email Address: Applicant Address: Phone/Cell: Street Address of RV Location: Owner of Real Property: Written authorization obtained – must be attached Proposed Dates: II. Submittal Instructions Submit To: City of Jerome Planning and Zoning, 152 E Avenue A, Jerome ID, 83338 Application Must Contain: □ Completed Application □ Owner’s Written Authorization I acknowledge that the RV must remain mobile and road-worthy at all times. I understand the RV may connect to electricity, but not to any residential cleanouts or street manholes. IV. Office Use Only Date Received: Received By: Date Approved: Expiration Date: III. Penalty Clause and Applicant Signature Penalty Clause: Any person found in violation of this section shall be guilty of an infraction and subject to a fine of $50. A second violation within one year of the previous offense shall constitute an infraction and be subject to a $100 fine. Any subsequent offense(s) within one year of the previous offense(s) shall constitute a misdemeanor, punishable by up to six months in jail, up to a $300 fine, or both such jail and fine. Signature of Applicant: I hereby certify that I am the applicant named herein, and that I have familiarized myself with the rules and regulations with respect to preparing and filing this application, and that the foregoing statements and answers herein contained, and the information on the attached documentation and materials, are in all respects true and accurate to the best of my belief. Applicant’s Signature Applicant’s Printed Name Date