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Revised 04-19-2023 Page 1 of 2 **May be signed by the applicant or representative, authorization letter from owner must be attached. If there are multiple owners, a letter authorizing one owner to be the authorized representative for all must be included. File Date: Intake Staff: Check Amount: Acct 1000 101000 341068 Date Complete: City of Whitefish Planning & Building Dept 418 E 2nd St │PO Box 158 Whitefish, MT 59937 Phone: (406) 863-2410 PRELIMINARY WATER QUALITY PROTECTION DETERMINATION FEE ATTACHED $ The purpose of the preliminary water quality protection determination is to assist property owners, or their representative, in determining the types of review that might be required to comply with the water quality protection regulations prior to a specific development plan. This type of determination might be ideal for one looking to sell or purchase a piece of property, but has no plans to develop the property. The user of this form may only know the general boundaries of a building improvement area or building envelope, but does not know the exact footprint of the building and driveway. INSTRUCTIONS: Submit the application fee, completed application and appropriate attachments to the Whitefish Planning & Building Department. After a completed application is received, city staff will review the materials, conduct a site visit and provide a written response to the owner/applicant of any possible future analysis or reports that might be needed to fully develop the property. A. PROJECT INFORMATION: Project Address: Assessor’s Tract No.(s) Lot No(s) Block # Subdivision Name Section Township I hereby certify that the information contained or accompanied in this application is true and correct to the best of my knowledge. The signing of this application signifies approval for the Whitefish staff to be present on the property for routine monitoring and inspection during the approval and development process. Owner’s Signature** Date Print Name Applicant’s Signature Date Print Name Representative’s Signature Date Print Name (see current fee schedule) SIGN SIGN SIGN ---PAGE BREAK--- Revised 04-19-2023 Page 2 of 2 B. APPLICATION CONTENTS: Attached ALL ITEMS MUST BE INCLUDED - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED One printed copy and one electronic copy of the application and supplemental materials. (if requesting review for multiple lots, complete a separate form for each lot) Vicinity Map A site plan, drawn to a suitable engineering scale (such as showing: • boundaries of the subject property; • a building improvement area – this should be greater than an exact building footprint, but less than the entire lot; • name of adjacent rights-of-way; • location of critical stormwater conveyances, rivers, streams, wetlands, or lakes on property or within 200-feet; and • topography of the site at two-foot contour intervals, with slopes 10% or greater highlighted Any other additional information relevant to the property C. OWNER/APPLICANT INFORMATION OWNER(S) OF RECORD: Name: Phone: Mailing Address: City, State, Zip: Email: APPLICANT (if different than above): Name: Phone: Mailing Address: City, State, Zip: Email: For City Staff Use Only Water Quality Protection Area maps indicate any water quality protection areas on-site? PRELIMINARY DETERMINATION: STUDY REQUIRED: NO FURTHER REVIEW REQUIRED: Written Determination Sent On: Reviewed by: Date: