TO: ST. LOUIS COUNTY GOVERNMENT
DEPARTMENT OF PUBLIC WORKS

TELEPHONE #314-615-5184

FROM: CITY OF BLACK JACK, MO 63033
MUNICIPALITY

PROJECT INFORMATION:

PROJECT ADDRESS*

BLACK JACK, MO 63033

TENANT NAME*

TENANT TELEPHONE NUMBER*

DESCRIPTION OF PROJECT*

BUSINESS NAME*

OWNER'S NAME AND ADDRESS*

APPLICANT NAME AND ADDRESS*

CONTACT NUMBER*

EMAIL*

THE CITY OF BLACK JACK REQUIRES A COPY OF THE PLOT PLAN AND ONE SET OF SUPPORTING DOCUMENTS FOR THE PROPOSED PROJECT.

Email those documents to deputycourtclerk@cityofblackjack.com.

A $100 APPLICATION FEE IS DUE WITH THIS APPLICATION. ACCEPTED FORMS OF PAYMENT ARE MONEY ORDER, CASHIER’S CHECK OR CREDIT CARD (ADDITIONAL USER FEE IS ASSESSED FOR CARD TRANSACTIONS), NO PERSONAL OR COMPANY CHECKS ARE ACCEPTED.

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FOR OFFICE USE ONLY DO NOT WRITE BELOW THIS AREA

ZONING APPROVAL:

MUNICIPAL ZONING CLASSIFICATION:

IS THIS PROJECT LOCATED IN A FLOOD PLAIN?

YES

NO

MUNICIPAL ZONING APPROVAL* BY:

DATE:

TITLE OF APPROVING MUNICIPAL OFFICIAL:

*For Municipalities that also contract for Land Disturbance Code enforcement, Zoning Approval includes municipal approvals for municipal and private roadways (proposed and existing), flood plain management regulations, applicable private storm conveyance and/or control system regulations, collection and administration of site development escrows, and other applicable municipal laws and regulations.
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NOTE: Applicants for building and/or land disturbance permits must submit this form together with four (4) copies of the site plan approved, signed and dated by the Municipal Official to St. Louis County, Department of Public Works in order to obtain the permit. Applicants may file their application for permit with the County to start the County’s review process while they finalize obtaining their Municipal Zoning Approval; however, the permit will not be issued until the Zoning Approval is received. Applicants should verify that the use and building/parking lot configuration on the site is approvable by the Municipality before submitting to the County.

ST. LOUIS COUNTY PERMIT APPLICATION NUMBER (IF KNOWN)