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CITY OF SALEM - PERMIT APPLICATION CENTER
555 LIBERTY STREET SE
ROOM 320
SALEM, OR 97301
503-588-6256
LAND USE APPLICATION
Project Address/ Legal Description Assessors Parcel # Total Acres/Sq. Ft.
Applicant Name Home/Bus. Phone # Cell Phone # FAX Phone #
Applicant Address City State & ZIP
Representative's Name Home/Bus. Phone # Cell Phone # FAX Phone #
Representative's Address City State & ZIP
Existing Use of Subject Property Comp. Plan designation Curent Zoning
Proposed Use or Type of Development of Subject Property
Authorization By Property Owners (To Be Completed By The Applicant)
(NOT REQUIRED FOR URBAN SERVICE AREA AMENDMENT)
Property owners and contract purchasers are required to authorize the filing of this application and must sign below. All signatures represent that they have full legal capacity to and do hereby authorize filing of this application and certify that the information and exhibits herewith submitted are true and correct.
Signature Name (Print or Type) Address City, State & ZIP
















DATE:

FOR STAFF USE ONLY
Received By: Date: Receipt #:
Type Application: Data Management System #: Zone Map #:
Council Person: Ward #: Pre-Application File #:
P.W. Notified: Date Application Complete:

I. TYPE OF APPLICATION (to be completed by the applicant)
NOTE: Since this is a comprehensive application form, only those items related to your specific type of application are to be completed.
NOTE: Multiple issues one application except for combined Comprehensive Plan Change/Zone Change (75% of the total charges for an application with multiple issues decided by the same body).
* Application fees include a non-refundable $15 Permit Application Center processing/automation fee.
COLUMN 1 COLUMN 2
Pursuant to the Salem Revised Code, application is made to the Planning Division of the City of Salem for the following:

Indicate type of application(s) filed and include requested information

Number refers to additional data which must accompany a particular application (refer to number and explanation on following page).
____ ADJUSTMENT, ZONING From section(s) ________ 1, 2, 4, 5, 8
____ ADJUSTMENT, PROPERTY LINE 13
____ MOBILE HOME PARK
____ Total number of Mobile Home spaces to be created.
1, 2, 3, 4, 8, 19
____ CONDITIONAL USE 1, 2, 3, 4, 5, 8, 19
___ ADMINISTRATIVE CONDITIONAL USE 1, 2, 3, 4, 5, 6, 14
____ HISTORIC DESIGNATION 1, 2, 4, 5, 8
____ GREENWAY DEVELOPMENT PERMIT 1, 2, 4, 5, 8, 19
____ COMPREHENSIVE PLAN CHANGE/ZONE CHANGE
Reclassifying the area from _____ designation to _____ designation.
Reclassifying the described property from a _____ District to a _______ District.
1, 2, 3, 4, 5, 8
____ ZONE CHANGE
Reclassifying the described property from a _____ District to a _______ District.
1, 2, 3, 4, 5, 8
____ VARIANCE
From section(s) _____________ of the Salem Revised Code (SRC).
1, 2, 4, 5, 8, 19
____ STREET NAME CHANGES AND STREET NAMING 15
____ ANNEXATION (Indicate requested zone district below)

____ ZONE CHANGE FOR ANNEXED AREA
Reclassifying the described property from a ______ District in ______ County to a _______ District.
OR
____ Waive the privilege of requesting a particular zoning classification for the area/properties petitioned for annexation.
1, 2, 4, 7, 11

1, 2, 3, 4, 5, 8, 11


No additional data required.

____ COMPREHENSIVE PLAN AMENDMENT
Reclassifying the area from _____ designation to a ______designation.
1, 2, 4, 5, 8
____ UGA DEVELOPMENT PERMIT (SRC Chapter 66) 1, 2, 4, 10
____ PLANNED UNIT DEVELOPMENT

_______Total number of lots to be created.
1, 2, 3, 4, 5, 8, 19
____ SUBDIVISION 1, 2, 3, 4, 6, 9, 19
____ LAND PARTITIONING 1, 2, 3, 4, 6, 9, 19
____ EXPEDITED SUBDIVISION Per ORS 197
____ EXPEDITED PARTITION Per ORS 197
____ URBAN SERVICE AREA AMENDMENT 1, 10, 18
____ TREE REGULATIONS
____ Discretionary Tree Plans
____ Hazard/Diseased Trees; Restoration
____ Variances from Tree Regulations
____ Appeal of Planning Administrator Decision
____ Non-Discretionary Tree Plan

8, 19
8, 20, 21
check with Planning Division
check with Planning Division
check with Planning Division
____ CONVERSION OF EXISTING MOBILE HOME PARK
TO A SUBDIVISION
1, 2, 3, 4, 6, 9, 19
____ URBAN SERVICE AREA AMENDMENT 1, 10, 18
____ LEGAL LOT OPINION check with Planning Division
____ PROPERTY BOUNDARY VERIFICATION (to
accompany review of building permits)
1, legal description of boundary
____ REPLAT (to reconfigure and/or consolidate three or less
lots and parcels in previously recorded subdivisions and partitions)
1, 4, 9, 19

INFORMATION SHEET

ADDITIONAL DATA (EXHIBITS) - COLUMN 2

See application form, column 2, for a list of items required for each type of application.

1. RECORDED DEED/LAND AND SALES CONTRACT WITH LEGAL DESCRIPTION - EXHIBIT B

A copy of the recorded deed/land sales contract of the total contiguous ownership of the applicant must accompany an application. If the land use request is only for a portion of the total ownership, include a second recorded deed/sales contract with the legal description for that portion which is to be reviewed with the application.

2. PROPERTY OWNERS WITHIN NOTIFICATION AREA - EXHIBIT C

An accurate list of the names and addresses of all owners of the property within the notification area, as indicated below.*

Notification lists for Marion and Polk Counties will be prepared by the City for a $17 fee.

*Notification area is the area measured a distance of 250 feet, equi-distant from the boundaries of the subject property.

*In addition, for Minor Plan Changes, when street rights-of-way are stubbed into the area proposed for change, the notice area shall be increased to include all properties abutting such stubbed streets to the nearest intersection.

3. TRIP GENERATION ESTIMATE

A Trip Generation Estimate form must be completed by the applicant and submitted to the Department of Public Works, Traffic Engineering Section. The Traffic Engineering Section will use the Trip Generation Estimate to determine whether or not a Transportation Impact Analysis (TIA) is required for the application. If a TIA is not required, the completed and approved Trip Generation Estimate must be attached to the application. If a TIA is required, the TIA must be completed and approved by Public Works prior to completion of all land use applications.

4. ASSESSOR'S MAP - EXHIBIT D

Attach an official copy of the County Tax Assessor's Map showing the entire notification area and the area described by the legal description. (Note: The Notification Area includes the property abutting all boundaries of the subject property including those properties that would be abutting if there were no intervening streets.) The applications for properties within Marion and Polk County must include the corresponding property owner Index Sheet also. Photocopies will NOT be accepted.

5. PROPOSAL DESCRIPTION/REASONS FOR APPLICATION - EXHIBIT E

Attach a statement describing the proposal and addressing the appropriate criteria outlined in the zoning ordinance to justify the proposed land use. (The criteria is listed on the attached sheet under the heading of "Considerations.") Also include any conditions that would be a part of this approval.

6. CONCURRENT VARIANCES WITH SUBDIVISION/PARTITIONING APPLICATIONS - EXHIBIT E

Attach a written statement requesting a variance and addressing the Basic Conditions for a Variance per Salem Revised Code (SRC) 63.332 as described on the attached instructions for subdivisions and partitionings, and citing the specific Code sections requested to be varied.

7. PROPOSAL DESCRIPTION/REASONS FOR ANNEXATION PETITION - EXHIBIT E

Attach a brief statement describing the existing land uses and the reasons for requesting annexation.

8. PLOT PLAN - EXHIBIT F

Follow plot plan instructions and graphic example of Plot Plan. Aerial photos will NOT be accepted. (Submit one reproducible plan (8-1/2" x 11") and a plan drawn to scale.)

9. TENTATIVE PLAN FOR SUBDIVISION/PARTITIONINGS - EXHIBIT F

Attach one reproducible plan (8-1/2" x 11") and one copy presented to scale. The tentative plan must include all the information included on the instruction sheet for tentative plans attached.

10. VICINITY MAP FOR UGA PERMIT AND/OR URBAN SERVICE AREA AMENDMENT - EXHIBIT F

Attach one reproducible vicinity map (8-1/2" by 11") and 15 clear, legible copies (scale: 1 inch equals 800 feet). The vicinity map must show the outline of the proposed development and its relationship to all existing designated arterial streets within a one-mile radius. Attach a written description of the proposed use of the property and proposed dwelling unit density.

11. ANNEXATION PETITION - EXHIBIT G

For annexation cases, the owners and/or contract purchasers must complete the annexation petition and the annexation questionnaire, Exhibit G.

12. SIGN VARIANCE - EXHIBIT H

Information that is required for sign variance applications - Exhibit H.

13. LOT LINE ADJUSTMENT - EXHIBIT I

See Lot Line Adjustment application requirements, Exhibit I.

14. FREESTANDING SUPPORT STRUCTURES AND EQUIPMENT - EXHIBIT H

In addition to any other information generally required under SRC 110.210, the applicant shall provide: (1) an evaluation of the feasibility of collocation of the subject facility as an alternative to the requested permit; (2) alternatives for locating/relocating support structures within 250 feet of the proposed location; and (3) analysis of the visual impacts of the proposed facility on residential dwellings within 250 feet of the proposed site, and an assessment of potential mitigation measures, including relocation.

15. STREET NAMING AND STREET NAME CHANGES - EXHIBIT J

See Street Naming and Street Name Changes application requirements, Exhibit J.

16. PRE-APPLICATION CONFERENCE - EXHIBIT K

See pre-application conference application requirements, Exhibit K.

17. PROJECT PLAN SUBMITTAL - EXHIBIT L

See project plan submittal application requirements, Exhibit L.

18. URBAN SERVICE AREA AMENDMENT

Attach a written description of proposed facilities and any proposed funding, including the CIP.

19. TREE CONSERVATION PLAN - EXHIBIT M

See project plan submittal application requirements - Exhibit M.

20. REMOVAL OF HAZARD OR DISEASED TREES - EXHIBIT N

See project plan submittal application requirements - Exhibit N.

21. REMOVAL OF TREES AND VEGETATION FOR RESTORATION - EXHIBIT O

See project plan submittal application requirements - Exhibit O.

 

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Community Development
555 Liberty St SE
Room 305
Salem, OR 97301
503-588-6173
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Page Last Modified: July 21, 2006

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