Ford County Planning, Zoning Zoning Certificate Application (building permit)
and Environmental Health Office Use Only  
100 Gunsmoke, Dodge City, KS 67801 Parcel #:  
Phone:  (620) 227-4739 Permit #:  
Fax:  (620) 227-4717                        1/4          Section            Township            Range
http://www.fordcounty.net    
Owner Information  Applicant Information (if different)
Name of applicant   Name of applicant  
Mailing address   Mailing address  
City             State                                Zip code City             State                                Zip code
Telephone #             Email address Telephone #             Email address
Building information: Draw plan here (include dimensions, driveway, ground slope, wastewater,
Site Address:   systems, water wells, natural bodies of water, corrals, outbuildings,
Number of acres:   and other potential sources of contamination.  Include an arrow indicating
Flood zone?  ______ north.)
Estimated cost:  
Dimensions:      
Structure type:      
Estimated completion date:    
Natural ground slope (direction):  _______________________    
Intended Use:      
Distance of bldg. from property lines (insert on next line):     
Feet from ___ N ____ S       Feet from ____ E  ____  W    
If less than 200 feet from natural body of water,                                         how many feet     ___ river   ____ stream ____ pond ____ lake    
Manufactured home?                   If yes, copy of title required.    
If manufactured home, see requirements.    
Contractor name:      
Contractor address:      
Contractor phone #:      
Setback Requirements
Acreage Front Side Back
40 acres 75 50 50
10 acres 75 50 50
2 acres 50 20 25
20,000 sq ft 30 15 20
The undersigned certifies that the information given herein is correct and that they will comply with the Zoning Regulations, and further understands a certificate issued upon false statement of any fact which is material to the issuance hereof shall be void.  Certificates, when issued, DO NOT NULLIFY ANY DEED RESTRICTION VALIDLY FILED OF RECORD.
Owner signature:   Date:  
FOR OFFICE USE:  
Manufactured Homes:                                     In Floodplain?
Year   Floodplain zone:  
Make   Elevation certificate?
Model   Need sanitary permit?
Width   Water well?  
Length   Waste water?  
VIN#:   Floodproofing certificate?
Well: Latitude   Longitude
Driveway: Latitude   Longitude
Septic: Latitude   Longitude