Certificate Of Land Use Compliance Form (Page 2 of 2) in pdf

Certificate Of Land Use Compliance Form Page 2

OWNER(S) ACKNOWLEDGEMENT

I hereby make application and declaration that I intend to construct a structure solely in

conjunction with an "agricultural use" and "not for human occupancy", both as defined

previously. I understand that as an exempt building, the Town of Castle Valley and the Grand

County Building Department has not reviewed the plans for the structure and has therefore not

made any implied or in fact approvals of any safety, structural integrity, building design, or

similar issues. I further understand that this structure may not be converted to a residential

building, a non-agricultural storage building, or any other non-agricultural related use without

obtaining a building permit, which includes complying with the zoning requirements for the zone

in which the structure is located, and that such permit may require significant modifications to

the structure in order to comply with the applicable Codes in effect at that time. Any misleading

or incorrect answers may constitute an act of falsification of government records under Section

76-8-511 of the Utah Code Annotated or issuing a written false statement under Section 76-8-

504 of the Utah Code Annotated, both of which are Class B misdemeanors. I hereby declare

under penalty of perjury that this application form, and all information submitted as part of this

application form is true, complete, and accurate to the best of my knowledge.

Owner(s) Signature: ___________________________________________Date:_____ Please

Print Name: ____________________________________________

ACKNOWLEDGEMENT: TOWN OF CASTLE VALLEY On this _______day of

_____________, 20_____, before me personally appeared ________________________(owner),

and did state upon his/her oath that he/she is the owner of the above described real property in

Grand County, Utah, and that the foregoing instrument was acknowledged before me.

Witness my hand and official seal. _______________________________________

Notary Public My commission expires:____________________

Edited 4/6/11

Certificate Of Land Use Compliance Form Page 2