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THIS CHANGE OF ZONE APPLICATION MUST BE ACCOMPANIED BY THE FOLLOWING: <br />I . A filing fee of five hundred dollars ($500) plus twenty-five dollars ($25) per lot or unit proposed by the <br />amendment. (Checks shall be made payable to the County Director of Finance) <br />2. An original and twenty (20) copies of this completed application and the appropriate Departmental Zoning <br />Questionnaire, <br />3. An original and twenty (20) copies of a Background and County Environmental Report to include <br />information as listed on the attached form. Note: A County Environmental Report shall not be required <br />for an application where an Environmental Impact Statement or Environmental Assessment has been <br />completed and filed with the Office of Environmental Quality Control in compliance with HRS, Chapter <br />343, Environmental Impact Statements. <br />4. An original and twenty (20) copies of a location map. <br />5. An original and twenty (20) copies of a scale -drawn plot plan of the property showing property lines and <br />measurements; all existing and proposed structures, uses and improvements; proposed subdivision; and <br />reference points such as roadways, shoreline, etc. <br />6. One copy of a full-size (2' x 3') scale -drawn plot plan of Item 5 for presentation purposes. <br />7. A legal description of the property in map and written form by metes and bounds as certified by a surveyor <br />shall be submitted with this application. This application shall not be considered complete unless the metes <br />and bounds description in map and written form have been received. <br />8. A list of the names, addresses and tax map keys of all owners and lessees of record of surrounding <br />properties who are required to receive notice. <br />9. A certificate of clearance from the Director of Finance that the real property taxes and all other fees <br />relating to the subject parcel(s) have been paid; and there are no outstanding delinquencies. <br />10. One of the following regarding archaeological resources: <br />1. An archaeological inventory report containing significance assessments, effect <br />determinations, and proposed mitigation commitments. The report should be completed <br />pursuant to State Department of Land and Natural Resources Historic Preservation Division <br />(DLNR-SHPD) rules. <br />2. A "no effect" letter from the State DLNR Historic Preservation Division. <br />3. A copy of a letter written by the applicant to the State DLNR Historic Preservation <br />Division requesting a "no effect" letter, including supporting documentation, to which <br />SHPD has not responded after 30 days (SHPD's time limit under their rules). <br />it. Any other plans or additional information relevant to this application may be requested by the Planning <br />Director to facilitate processing of this request. <br />FORMS - 8/03 <br />fakHX3 <br />