Ford County Planning, Zoning Zoning Certificate Application (zoning certificate)
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 (__)s Range (__)w
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#________________ E-mail address _____________ Telephone#________________ E-mail address __________
Building Information Draw plan here (include dimensions, driveway, ground slope, waste water,
Site Address: systems water wells, natural bodies of water, corrals, outbuildings, and
Number of acres: other potential sources of contamination. Include an arrow indicating north.)
Flood Zone?  
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 Manufacture 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 ANDY DEED RESTRICTION VALIDLY FILED OR RECORD.

Owner or Applicant Signature:______________________________________ Date: ____________
FOR OFFICE USE:
Manufactured Homes:                                                                                                                         In Floodplain?
Year Floodplain zone:
Make Elevation certificate?
Model Need sanitary permit?
Width Water well?
Length Culvert Permit?
VIN# Floodproofing certificate!
Well: Latitude                                                                     Longitude
Driveway: Latitude                                                                     Longitude
Septic: Latitude                                                                     Longitude