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Page 1 Revised 12-20-2023 City of Whitefish Planning & Building Dept. 418 E 2nd St │PO Box 158 Whitefish, MT 59937 Phone: (406) 863-2410 SUBDIVISION EXEMPTION APPLICATION FEE ATTACHED $ (See current fee schedule) INSTRUCTIONS: □ Submit the application fee, completed application and appropriate attachments to the Whitefish Planning & Building Department. □ Once approved, Planning staff will forward the original letter to the Surveyor on the application unless directed otherwise. A. LEGAL DESCRIPTION OF PROPERTY: Street Address Assessor’s Tract No.(s) Lot No(s) Block # Subdivision Name 1/4 Sec 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 Signature1 Date Print Name Applicant’s Signature Date Print Name Representative’s Signature Date Print Name 1 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 341070 Date Complete: ---PAGE BREAK--- Page 2 Revised 12-20-2023 APPLICATION CONTENTS: Attached Certificate of Survey (showing as-built information for any existing structures, eaves and access; clearly showing the old and new boundaries) Vicinity Map Municipal Facilities Exclusion, if within the city’s service area Signed Affidavit (attached) B. OWNER(S) OF RECORD: Name: Mailing Address: City, State, Zip: Email: TECHNICAL/PROFESSIONAL: Name: Phone: Mailing Address: City, State, Zip: Email: C. TYPE OF EXEMPTION SOUGHT: □ Gift or Sale to a Member of the Immediate Family 76-3-207(1)(b)]: Complete Section D. □ Relocation of Common Boundary 76-3-207(1)(a), Complete Section E. □ Townhouse 76-3-203]: Complete Section F. □ Other: : Complete Section G. D. FAMILY TRANSFER SUBMITTAL REQUIREMENTS: □ Zoning Classification: □ Name of Grantee: □ Relationship to Grantor: □ Parcel to be Conveyed Under this Exemption: □ Has the Grantor Used a Family Transfer in Flathead County? (Yes/No): o If Yes, include date, name, exemption used and Certificate of Survey: □ How will access be provided to the parcel being created: □ How will utilities be provided: ---PAGE BREAK--- Page 3 Revised 12-20-2023 E. BOUNDARY LINE ADJUSTMENT SUBMITTAL REQUIREMENTS: □ Zoning Classification: □ Minimum Lot Size Required in Zone: □ Number of Lots Affected: □ Gross Area of Lots Before and After the Lot Line Relocation: □ Will access to the lots change? If so, describe: □ How will utilities be provided: F. TOWNHOUSE SUBMITTAL REQUIREMENTS: □ Zoning Classification: □ Did the original subdivision of land expressly complete the construction of townhouses? o If Yes, name of Subdivision: o If No, project is not eligible for this Exemption. □ Did the original subdivision comply with the parkland dedication requirements? o If Yes, describe how: o If No, project is not eligible for this Exemption. □ Is the proposal in conformance with applicable local zoning regulations? o If Yes, describe how: o If No, project is not eligible for this Exemption. G. OTHER EXEMPTION REQUESTS: □ Identify the applicable MCA: □ Describe the purpose of the exemption: □ Are any required notes on the face of the COS? o If Yes, describe: ---PAGE BREAK--- Page 4 Revised 12-20-2023 City of Whitefish Planning & Building Department PO Box 158 Whitefish, MT 59937 Subdivision Exemption Affidavit Date: Flathead County Plat Room 800 South Main Street Kalispell, MT 59901 The City of Whitefish has checked the survey described below and has found it to be in compliance with applicable zoning and subdivision regulations. Surveyor: Owner: Survey: Section Township Range Purpose: The City is also requesting your review of this survey for compliance with established subdivision evasion criteria. Please notify our office if there are any issues related to this survey – including any changes or if you have any questions. Sincerely, City of Whitefish Planning Department ---PAGE BREAK--- Page 5 Revised 12-20-2023 It is hereby understood that this Affidavit seeks approval of the use of an exemption to subdivision review. It is also understood that approval of the use of the exemption is not approval under zoning, health, floodplain or other applicable regulations. Under penalties of perjury, I / We declare that we have examined this form, including the accompanying Certificate of Survey, and to the best of our knowledge and belief, it is true, correct and complete and is in compliance with all Montana State laws and City of Whitefish ordinances and resolutions and the purpose of the survey for that which is stated. Owner(s) – all must sign the application Date Please Print Name Owner(s) – all must sign the application Date Please Print Name Owner(s) – all must sign the application Date Please Print Name Owner(s) – all must sign the application Date Please Print Name