HomeMy WebLinkAboutMFE - 2019.10.18 - Copy MUNICIPAL FACILITIES EXCLUSION CHECKLIST
Required under § 76-4-127 MCA
(formerly called master plan exclusion)
1. Does this subdivision affect property with an existing Title 76-4 Approval?Yes No x
If yes,then you may not use the Municipal Facilities Exclusion for this subdivision
2. Name of Subdivision: L Yo%J 1z, ?)0 'iJ D�,,?-Y' Lim+' P'- Sz �v�r✓r.r�
3. Name and address of the applicant: GP t:j
l Zvi S F_wb-' MONN 51 NC\ 59-715
4. Name and address of engineer: ��AV__'e_ A.N`L-)c e Z
loll Iylt { 17E E►Nac.�� w�T 5`1-7
5. Location of the subdivision to the city or town, vicinity map attached: Yes 'X No
6. Copy of the Plat or Certificate of Survey or Unit Declaration and floor plan with exemption
citation: Attached >� .
7. Number of parcels or units in the subdivision: 2-
8. A copy of any applicable zoning ordinances in effect: Ow Y kLe
9. Copy of Growth Policy, if applicable: On file _C Attached:
10. Will an extension of the existing sewer main(s)be necessary to serve this subdivision?
Yes No X
11. Will an extension of the existing water main(s) be necessary to serve this subdivision?
Yes No x
12. How construction of the sewage disposal and water supply systems or extensions will be
financed. : N f R F-11,JANLE-0
13. Has the governing body reviewed and approved plans to ensure adequate storm water drainage
Yes No
14. Exclusion Checklist review fee, ($100) included: Yes�X No
I certify that the subdivision or division is within an area covered by a growth policy pursuant to Title 76,
chapter 1, MCA, or within a first-class or second-class municipality, as described in Section 7-1-4111,
MCA.
I certify that adequate storm water drainage and adequate municipal facilities will be provided for the
subdivision. I further certify that the governing body has reviewed and approved plans to ensure adequate
storm water drainage.
For subdivisions subject to the Montana Subdivision and Platting Act, I certify that adequate municipal
facilities for the supply of water and disposal of sewage and solid waste are available or will be provided
within the time provided in Section 76-3-507, MCA.
I further certify that I am authorized to sign this form on behalf of the governing body.
Name Signature
Dept Title
City Zip Phone
Please sign and send with the $100.00 review fee to:
MONTANA DEPARTMENT OF ENVIRONMENTAL QUALITY
SUBDIVISION REVIEW SECTION, PERMITTING AND COMPLIANCE DIVISION
PO BOX 200901
HELENA, MT 59620
Revised 06/17