HomeMy WebLinkAboutFORM A1 Home Based Business 2 Application
FORM A1: HOME BASED BUSINESS 2 APPLICATION
A completed Development Permit Application must be submitted in addition to this form.
County of Newell | Home Based Business 2 Application | Land Use Bylaw 2016-21 Page 1 of 2
183037 RR145 (Box 130), Brooks, AB T1R 1B2
Office Hours: Mon-Fri 8:00 a.m. – 4:30 p.m.
Email: administration@newellmail.ca
Web: www.countyofnewell.ab.ca
Phone: 403-362-3266
Permit No.
Revised 2023-09-20
1. APPLICANT INFORMATION
Applicant Name:
2. DEVELOPMENT INFORMATION
a. Is there a Home Based Business currently operating on the site?
Yes No
If yes, what is the nature of the Home Based Business and associated development permit numbers:
______________________________________________________________________________________________
b. The proposed new Home Based Business will be:
On-site Off-site/Mobile
Describe the business, including the goods and/or services to be provided, and the other locations if off-site/mobile:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
c. The proposed new Home Based Business will operate:
In the dwelling In an accessory building
If the business is in the dwelling, attach a floor plan showing which rooms the business will use in its operation.
Attached floor plan Date: _____________________________
d. Operating Information:
Number of days per week: _________, from _____ to _____ (hours)
Number of resident employees: _______ Non-resident employees: _______
Anticipated customer visits: _______ per day/week/month (circle one)
Number of parking spaces for clients, employees, and deliveries _______
(show parking area on the Development Permit site plan with dimensions and number of stalls)
e. Are there any commercial vehicles/trailers that will be used in conjunction with the business?
Yes No
If yes, describe the number, type and size of all applicable vehicles/trailers:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
County of Newell | Home Based Business 2 Application | Land Use Bylaw 2016-21 Page 2 of 2
Revised 2023-09-20
f. Are outdoor storage areas required?
Yes No
If yes, describe what is to be stored and show location(s) on the Development Permit Application site plan:
______________________________________________________________________________________________
______________________________________________________________________________________________
g. Are flammable or hazardous materials used for the business?
Yes No
If yes, list the type and quantity to be stored:
______________________________________________________________________________________________
______________________________________________________________________________________________
h. Are signs being installed for the business?
Yes No
If yes, complete Form A3: Sign Application and show on the Development Permit Application site plan:
______________________________________________________________________________________________
______________________________________________________________________________________________
3. DECLARATION OF APPLICANT / REGISTERED OWNER
The information given on this form is full and complete and is, to the best of my knowledge, a true statement of the facts in relation to the
application for a Home Based Business 2. I consent to an authorized person designated by the municipality to enter upon the subject land
and buildings for the purpose of an inspection during the processing of this application.
Date: _____________________ Applicant Signature: ________________________________________________
Registered Owner: ______________________________________________________ __________________________
(Required, if different from applicant) Print Name Signature
OR
Written approval has been submitted by the registered owner stating that the applicant is authorized to sign the application form.
Date written approval was submitted: __________________
FOIP Statement: The personal information required by this County of Newell application form is collected under the authority of section 33(c) of the Alberta Freedom of Information and Protection of
Privacy Act and will be protected under Part 2 of that Act and section 63 of the Alberta Safety Codes Act. It will be used to process the home based business application, prepare referral notifications
if needed, and to contact the applicant when required. The name of the applicant and nature of the application may be included on reports provided to the municipality or made available to the public
as required or allowed by legislation. Please direct any questions about this collection to the County of Newell at 403-362-3266 or 183037 Range Road 145, PO Box 130, Brooks, AB T1R 1B2.