BENTON COUNTY EXEMPT HOME AND RURAL FAMILY OCCUPATION APPLICATION FORM Page 3 of 9 REGISTERED OWNER AND APPLICANT INFORMATION Provide in full the name of the registered owner, agent/ applicant (if different than the owner) contact details.
Benton County Development Department Planning Division 2113 W. Walnut Street Rogers, AR 72756 (479) 464-6166 http://www.bentoncountyar.gov Date Stamp OWNER AFFIDAVIT - HOME AND RURAL FAMILY OCCUPATION Any use conducted entirely within a dwelling or an accessory building which is clearly incidental and secondary to the use of the dwelling and which does not change the residential character of the building and the surrounding area is classified as a Home Occupation. Home and Rural Family Occupations that meet all of the following criteria are allowed by right and exempt from review. Check all the applicable criteria: o Operate entirely within the dwelling or an accessory building with no more than twenty-five (25%) percent of the gross floor area of the home and or any accessory building utilized in the day to day operations of the home based business. o Home and Rural Family Occupations shall be operated and conducted primarily by the resident owner of the property. o Phone order, fax and or internet sales or sale of items that is clearly incidental to the farm activities or residential use of the site by the property owner. o Any commercial activity that shall be incidental to residential or farm activities and shall not meet the threshold for site plan review. o Any use that does not require a building code or septic upgrades (i.e. from residential standards to commercial standards) to accommodate the home and rural family occupation. o The home and rural family occupation does not display merchandise or have outside storage of equipment or materials visible from a public road or adjacent residence. If located outside the building such use shall be adequately setback and appropriately screened from adjacent properties. o The home and rural family occupation does not alter the external appearance of the dwelling unit or accessory structure and maintains the rural residential character. o The home and rural family occupation does not create noise, vibration, glare, fumes, electromagnetic interference, odors, or air and water pollution or any environmental concerns outside the dwelling unit or accessory building on site. o The home and rural family occupation does not involve the storage of hazardous materials, other than substances of a type and quantity customarily associated with a home or hobby. Further, the use of buildings or structures for the home occupation shall not involve the manufacturing, processing, generation or storage of materials that constitute a high fire, explosion or health hazard as defined by the International Building Code. o When located in a subdivision, the home occupation has no more than one non-illuminated business sign on the premises, not more than two square feet in area. In rural areas with lot sizes of 1 acre or more, one non-illuminated sign of nine square feet in area and six feet tall may be allowed. o The home and rural family occupation shall not warrant delivery or parking needs that have the potential to adversely affect traffic for adjacent and surrounding properties. Further, parking areas for residents, employees or customers and or loading areas shall be located on site, adequately setback and appropriately screened from adjacent properties. In subdivisions, parking of non-motorized vehicles, such as, boats, trailers, or flatbeds shall not be allowed unless adequately screened. See list of non-exempt home occupations including bed and breakfasts; kennels; towing services; auto wreckers; junkyards etc. PLEASE NOTE: INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED Page 1 of 9 BENTON COUNTY EXEMPT HOME AND RURAL FAMILY OCCUPATION APPLICATION FORM INSTRUCTIONS FOR APPLICANT: Applications must be submitted in person. Please make an appointment with a planner to discuss the proposed development and to determine if a complete application is submitted. Please review Site Plan Review Regulations prior to application submission (Chapter 7). Planning Board Calendar including meeting schedules (included with Application). Item Completed application with notarized original signatures 1. Fee- $100.00 2. Written Description of the proposal 3. Initial submission: Site Plans to scale - 1 copy 11"x17" *Confirm size with Planning Staff Final Approved Plan: 4 originals, no greater than 18"x24", 1 copy 11"x17" 4. All applicable forms as required. Service Agreement Forms Water, Electricity, Septic maintenance, Landscaping, Fire Protection, Solid Waste. Others as applicable to specific projects. Notification Letter (Review with staff prior to Mailing) 5. Submit all applicable State and Federal Permits Date Provided Provided (Yes/No) Staff Initial 6. Electronic versions of all materials, drawings and completed application form 7. Landscaping installation & Maintenance Plan 8. Any additional materials as needed by Staff or Planning Board or supplemental information 9. Request for Variance or waivers 10. Page 2 of 9 BENTON COUNTY EXEMPT HOME AND RURAL FAMILY OCCUPATION APPLICATION FORM REGISTERED OWNER AND APPLICANT INFORMATION Provide in full the name of the registered owner, agent/ applicant (if different than the owner) contact details. If the registered owner is a numbered company, provide the name of the principals of the company. If there is more than one owner, copy this page, complete in full and submit with this application. An authorized applicant and agent for the owner must attach a notarized letter of authorization from the legal property owner. Written authorization from the legal property owner is required at the time of application or the documents will not be accepted. Property Owner Name: Address: Phone: Email: Contact Person: Postal Code: Fax: Applicant / Agent(If other than the Property Owner) Please complete Form A and or B, attached Name: Contact Person: Address: Postal Code: Phone: Fax: Email: NOTARIZED OWNER CERTIFICATION I certify under penalty of the laws of the State of Arkansas that I am the property owner of the property that is the subject matter of this application and I am authorizing to and hereby do consent to the filing of this application, acknowledge that the final approval by Benton County, if any, may result in restrictions, limitations and construction obligations being imposed on this real property and hereby authorize Benton County Staff to enter my property for the duration of the review. I confirm that the information contained in this application and accompanying documents is accurate to the best of my knowledge. I hereby acknowledge that it is my responsibility to ensure that I am in compliance with all applicable laws, regulations, and permits at the State or Federal levels. Owner/Authorized Agent Print Name: ____________________________________________________________ Owner/Authorized Agent Signature: ______________________ Date: __________________ State of Arkansas, County of ___________________ Subscribed and sworn to before me this ______day of ____________201__. _______________________ NOTARY PUBLIC _____________________________ My Commission expires Page 3 of 9 BENTON COUNTY EXEMPT HOME AND RURAL FAMILY OCCUPATION APPLICATION FORM 3. DESCRIPTION OF SUBJECT PROPERTY a. Address: (If none currently, contact 911 Administration) b. Assessor's Parcel Number (s): c. Site Area (acres/ square feet): d. Area of Development (acres/ square feet): e. Existing Land Use: f. Proposed Development & Use: g. Parking/Loading Spaces # of Parking Spaces Total Loading Spaces Existing Proposed (New) h. Description of Screening/Buffer Proposed Screening Existing Fence (length and location, material) Landscape Buffer (length, size, spacing, and location) Other - Describe Total Proposed i. Building setbacks Front setback Side setback Rear setback Existing Buildings j. Access to Subject Lands: Check all that apply County Road, Name Private easement, Describe Proposed buildings Highway, Name k. Water, Sanitary Sewage and Storm Drainage: Check all that apply Water- Indicate the source of water on-site Public/Semi Public Private/Semi Private well Page 4 of 9 BENTON COUNTY EXEMPT HOME AND RURAL FAMILY OCCUPATION APPLICATION FORM Sanitary- Indicate the type of sewage disposal facility: Check all that apply Publicly owned and operated sanitary sewage system Privately owned and operated individual septic system Other Have you received approval from Heath Department? Yes No Approval awaited (Date) Storm Drainage- Indicate how storm drainage will be provided on-site: (Chapter X, Appendix D) Ditches Swales Retention pond Detention pond Bio retention pond Low Impact Development options (Appendix B) Other 4. I confirm that the information contained in this application and accompanying documents is accurate to the best of my knowledge. I hereby acknowledge that it is my responsibility to ensure that I am in compliance with all applicable laws, regulations, and permits at the State or Federal levels. Name and Signature of applicant State of Arkansas County of ___________________ Subscribed and sworn to before me this ______day of ____________201__. _____________________________ NOTARY PUBLIC _____________________________ My Commission expires Date Page 5 of 9 BENTON COUNTY EXEMPT HOME AND RURAL FAMILY OCCUPATION APPLICATION FORM OFFICE USE ONLY AUTHORIZATION TO PROCESS: This application has been received and accepted for processing Name of Planning staff Date of Authorization to process Item 1. Name of Planning Jurisdiction 2. Is the subject property located in a Yes Floodplain? No 3. Is the subject property located in County's Yes MS4 area? No 4. Date the applicant attended DRC 5. Service Agreement Forms (Form F)- Water, Electricity, Septic maintenance, Landscaping, Fire Protection, Solid Waste. Others as applicable to specific projects. 6. Site Visits Comment Application Fee: $ Assigned File No.: Additional Notes Receipt No.: Date: Related Planning File No.: Page 6 of 9 FORM A - NOTARIZED AUTHORIZATION OF REGISTERED OWNER FOR THE APPLICANT (OTHER THAN THE OWNER) TO SUBMIT THE APPLICATION If the applicant is not the registered owner of the land that is subject of this application, the written authorization of the registered owner that the applicant is authorized to make the application must be included with this application form and the authorization below must be completed. I (We), , (owner of the subject land, address or parcel No.) hereby authorize and instruct (applicant) to submit an application to the Benton County Development Department. This shall be my (our) good and sufficient authority to act on my (our) behalf and to negotiate or bond on my behalf. (Sign) Note: if the owner is a corporation, affix seal (if any) Date FORM B - NOTARIZED AUTHORIZATION OF REGISTERED OWNER FOR THE AGENT (OTHER THAN THE OWNER) TO SUBMIT THE APPLICATION AND BE THE ONLY POINT OF CONTACT WITH BENTON COUNTY PLANNING DEPARTMENT I (We), , (owner of the subject land, address or parcel No.) hereby authorize and instruct (agent) to submit an application to the Benton County Development Department. This shall be my (our) good and sufficient authority to act on my (our) behalf and to negotiate or bond on my behalf. (Sign) Date Note: if the owner is a corporation, affix seal (if any) FORM C - PERMISSION TO ENTER THE SUBJECT PROPERTY I hereby authorize the Planning Board and/or staff of Benton County, Arkansas to enter upon the subject lands and premises for the purpose of evaluating the merits of this application and subsequently to conduct any inspections and work on the subject lands that may be required as a condition of approval. This is their authority for doing so. Subject lands: Signature of owner State of Arkansas County of ___________________ Subscribed and sworn to before me this ______day of ____________201__. _____________________________ NOTARY PUBLIC _____________________________ My Commission expires Date Page 7 of 9 FORM D HAZARDOUS CHEMICAL COMPLIANCE FORM BENTON COUNTY DEPARTMENT OF EMERGENCY MANAGEMENT AND HOMELAND SECURITY 215 E. CENTRAL AVE #7, BENTONVILLE, AR 72712 Phone: 479-271-1004 Fax: 479-271-1084 BUSINESS NAME: ________________________________TYPE OF BUSINESS:________________ OWNER'S NAME:_________________________________________________ PHYSICAL LOCATION/ADDRESS:____________________________________________________ MAILING ADDRESS:_________________________________________________________ CONTACT PHONE NUMBER:_______________________________________________________ CONSULTANT/ENGINEER:_____________________________________________________ A LETTER WILL BE SENT TO THE BUSINESS OWNER AND THE PLANNING OFFICE. IF THERE ARE OTHER LOCATIONS PLEASE SPECIFY:________________________________ _____________________________________________________________________________________ WILL THERE BE CHEMICALS STORED AT THIS FACILITY? YES_______ NO_______ IF YES LIST NAME AND QUANTITIES BELOW: _____________________________________ ______________________________________ ____________________________________ ______________________________________ ____________________________________ ______________________________________ BY SIGNING BELOW, I ACKNOWLEDGE THAT ALL INFORMATION ABOVE IS TRUE AND CORRECT. I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO NOTIFY THE BENTON COUNTY DEPARTMENT OF EMERGENCY MANAGEMENT IF THIS INFORMATION CHANGES. _________________________ __________________ OWNER SIGNATURE DATE BENTON COUNTY DEPARTMENT OF EMERGENCY MANAGEMENT ONLY LETTER COMPLETED BY____________________________ ________________ DEM OFFICER DATE Page 8 of 9 FORM F- Letter of Service Confirmation Project Name: Property Owner: Map/Parcel No.: Project Address: The Benton County Development Department has received an application to review a: Site Plan Review Subdivision Other___________________________________ for the above mentioned property. In order to process this request, service coverage must be provided to the property. Please indicate if the above property is or will be receiving services from your utility or department. Should there be any conditions associated with the coverage to be extended to the above mentioned property please included those conditions in the appropriate area below. Department/Utility: ___________________________________________________________________ Type of Coverage: ________________________ ____________________________________________ Please note your comments or concerns below. If additional conditions or stipulations of coverage extension are required please include those stipulations below. Attach additional pages if necessary. If you have no comments, please indicate by checking the "no comment" box below: Conditions/Stipulations: _______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Other Comments: ____________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Thank you for your assistance, Submit to: Benton County Development Department Planning Division 1204 SW 14th Street, Suite 6 Bentonville, AR 72712 Office: 479-464-6166 Fax: 479-464-6170 Page 9 of 9Microsoft Word 2016