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2. Property Owner & Applicant Information

   Items marked with * are required fields for submission.

4. Name(s):*
6. Address:*
8. Primary Phone:*
10. Secondary Phone:
12. Primary Email:*
14. Secondary Email:
16. Property Information

    Complete the following as it pertains to the permit request.

18. Project Site Address:*
20. General Description of Project:*
22. How does the current application of an ordinance impose practical difficulties or particular hardship for your project?
24. Is your permit necessary because of exceptional topographical conditions or other extraordinary or exceptional situations or conditions of your property?
26. Will your permit impair the public health, safety, comfort, morals and welfare of Village of The Hills?
28. The following are requirements of permitted approval by the City Council for your review and acknowledgment.*

    1. Indemnification: Applicant agrees as a condition of granting the permit to indemnify and defend the City, its officials, employees, and agents from any and all liabilities, claims, or lawsuits arising from the use or occupancy of City-owned property by the applicant or applicant’s contractors under the permit.

    2. Performance Bond: As a condition of the permit, applicants may be required as a condition of granting the permit to provide the City with a performance bond (either cash or surety acceptance to the City) in an amount to be determined conditioned on your full performance of the requirements of the permit.

    3. Permitted Equipment: Only previously communicated and permitted equipment will be allowed for use. Any additional equipment added to the project after the permit is granted must be approved by the City Administrator.

    4. Neighborhood Impact: The City Council Members acknowledge that the construction process may affect nearby residents. Those more directly affected may be identified and contacted for their awareness by the City Administrator. If neighbors have any feedback on this potential project, they are to communicate with the City Administrator to advise of their agreement or concerns before the next council meeting.

    5. Reimbursement Agreement: Applicant must agree to reimburse any neighbors and/or the city for any damages incurred to the greenbelt, walkways, vegetation, or other city’s property during project activity.

    6. Timeline: Applicants must provide a start and finish timeline of when the greenbelt will be used and routinely update City Administrator on project progress.

    1. I agree
30. I authorize Village of The Hills to conduct any site visits necessary to evaluate this permit application.*

    1. I agree
32. I hereby state that I have prepared this application and that, to the best of my knowledge, the information contained herein is complete, accurate, and a true representation of the permit request. I have read and acknowledged the possible additional requirements to obtain an approved permit. I further attest that I have the authority to submit this application and agree to comply with any and all conditions of permit approval. I agree to provide any additional information requested by the City as they deem necessary for the processing of this application.*

    1. I agree

34. For security purposes, recaptcha may populate a request for form completion.

    Select an option below to finish (Submit or Submit & Print.) This completed form will be received electronically by the City Administrator. You may print a copy for your records.

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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

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