MDT Use Only Permit #: ______________ ☐ Approved ☐ Denied Date: _________________
OAC Agent
OAC Supervisor
SIGN OWNER/APPLICANT

First Name:
Last Name:

Address:	City, ST, Zip
Seasonal Address?	City, ST, Zip

Email:	Phone:	Permit #:

NEW LOCATION

Highway #:	Side of Hwy:	☐ North	☐ South	☐ East	☐ West

City/Town:	County:

Nearest Mile Marker or Address of Sign Location:

Estimated Longitude/Latitude in NAD 83 Decimal Degrees:	/

Land Zoned?	☐ Yes	☐ No	If yes:	☐ City	☐ County

APPLICATION FEES

Fees shall be transmitted with the application by check payable to the Montana Department of Transportation. For Credit Card use please contact OAC. The department assumes no responsibility for loss in transit of such remittances. Applicants not submitting proper fees will be notified by the department. The Inspection Fee is nonrefundable.

INSPECTION FEE $150.00

SIGN OWNER/APPLICANT CERTIFICATION

I agree to abide by the provisions on the reverse side of this application and 75-15-101, et seq., Montana Code Annotated, and 18.6.202, et seq., Administrative Rules of Montana. Upon approval, failure to stay in compliance with all local sign regulations may result in revocation of this sign permit. Providing incorrect or false information whether unintentional or not may result in permit revocation.

Approved relocation work must be completed within 90 days of department approval ARM 18.6.252

By my signature/typewritten name, I declare under penalty of perjury and the laws of the State of Montana that the foregoing is true and correct and contains no willful falsifications of misrepresentations.

Signature	Date	Place of Signature (City, State)

Average turnaround time for a completed permit application is 30 working days

NEW LOCATION DETAILED DRAWING

☐	Attached is an aerial photo of the proposed location.
☐	If no picture is attached, please fill in the information below

Sketch or provide an aerial view of proposed sign location corresponding to the appropriate side of the highway where you wish to build your sign. If applicable, the sketch should include references to the distance requirements described below.

Sign structures proposed along the interstate and primary highways must be located on private property and cannot be erected within or encroach upon the highway right-of-way. It is the sign owner's responsibility to ensure that the sign does not encroach upon the right-of-way. The Department will not assume responsibility for encroachments due to mapping errors. For un-zoned permit applications, please sketch Qualifying Activity's Building and indicate distance from proposed sign location.

R/W Line
Edge of pavement
Hwy # _______

☐	Township:	Range:
☐	Indicate North	☐
☐	Section:	County:

DISTANCE REQUIREMENTS

All Signs

Signs on interstate, limited access primary or National Highway System (NHS) must be minimum of 500 feet apart on the same side of the roadway.

Signs adjacent to non-limited access primary or NHS highways must be minimum 300 feet apart on the same side of the roadway.

Signs must not be located within 500 feet of an intersection in rural areas or within 140 feet in cities or towns unless the sign has a Height Above Ground Level (HAGL) as defined of at least 8'.

Signs must not be located within limits of a grade separated interchange which extends 500 feet beyond the beginning or ending of the gore.

Signs must not be located within 500' of the following unless the sign is within an incorporated area: Public Park, public forests, public playgrounds, cemeteries or scenic areas designated by the department or state agency.

EBB signs must not be located within 2,000 feet of existing OAC permitted signs.

Specific Signs (Off-Premise Signs)

The commercial or industrial permanent buildings used to qualify an un-zoned area must be located within 660 feet of the outer edge of right of way and sign location must be within 600' of the edge of the qualifying building.

SIGN OWNER/APPLICANT – LANDOWNER AFFIDAVIT

(or if applicable, attach copy of easement allowing sign)

I,	(print name – Sign Owner/Applicant

AND

I,	(print name – Landowner

by our signature do swear that the information given herein is true to the best of our knowledge and belief that we will comply with Montana Codes Annotated 75-15-101 through 75-15-134 and the Administrative Rules of Montana (ARM) 18.6.202 through 18.6.272 covering the granting, renewal, and revocation of permits for Outdoor Advertising and that the Agent for the applicant attests that they have the authority to contract in this matter and that the landowner does hereby acknowledge that the applicant has my consent to erect and maintain said advertising sign on my property and that both applicant, landowner, and their assigns herein grant to the Montana Department of Transportation (MDT) the right to enter the property in question for the purpose of inspecting said sign or remove any illegal sign. (MCA 75-15-131)

We also agree to hold MDT harmless and indemnify the Department for any damage caused either directly or indirectly by the erection and maintenance of said structure. In lieu of the landowner's acknowledgment, attach a lease or dated statement signed by the landowner (identify sign location by state route, County, side of roadway, and distance to milepost). Should the landowner be represented by an agent in this matter, documentation of said agent's authority which is satisfactory to the Department is required. A dated statement of lease must include a right of entry in favor of and acceptable to the Department for the purpose of inspecting said sign site or to remove any illegal sign.

By my signature/typewritten name, I declare under penalty of perjury and the laws of the State of Montana that the foregoing is true and correct and contains no willful falsifications of misrepresentations.

Signature	Date	Place of Signature (City, State)
Sign Owner/Applicant Signature

By my signature/typewritten name, I declare under penalty of perjury and the laws of the State of Montana that the foregoing is true and correct and contains no willful falsifications of misrepresentations.

Signature	Date	Place of Signature (City, State)
Landowner Signature

Landowner Address?
City, ST, Zip

Email:	Phone:

SIGNATURES REQUIRED BY BOTH SIGN OWNER/APPLICANT & LANDOWNER

LOCAL ZONING CERIFICATION

(to be filled out by Local Zoning Authority)

I hereby certify that the (City of) (County of):

☐ Does NOT have a zoning plan and ordinance of any kind
☐ Has zoning in the proposed sign location designated as:

Approved uses of this zoning type:

☐ Has other land use controls or ordinances in the proposed sign location
☐ Has specific sign ordinance/regulation which requires sign spacing of more than 500’ and/or size or heigh limits

Please specify:

I further certify that I have reviewed the description of the outdoor advertising structure described on the attached application and find the proposed sign is to be located in an area appropriate for such structures and is in compliance with all local laws, ordinances or regulations.

By my signature/typewritten name. I declare under penalty of perjury and the laws of the State of Montana that the foregoing is true and correct and contains no willful falsifications of misrepresentations.

Signature	Date	Place of Signature (City, State)
Authorized Official Signature

Authorized Official Title	Phone #

QUALIFYING BUSINESS DESCRIPTION

Qualifying Activity:

Business Name:

Address:	City, ST, Zip:

Manager/Owner:	Phone #:

If a proposed sign is located within an un-zoned area, a qualifying commercial or industrial activity must be present. By submitting and signing this Outdoor Advertising Application you agree the following qualifying activity requirements have been met.

The permanent buildings comprising a business used to qualify the area are within 660 feet of the right-of-way of an interstate or primary highway.

The qualifying activity is not located in what is primarily used as residential property.

The qualifying business has been in business for at least one year.

The permanent buildings or improvements comprising the business are clearly visible to the traveling public and easily recognizable as a commercial or industrial activity.

The business cannot be seasonal, temporary, or transient.

The qualifying activity must be open to the public during regular scheduled hours in excess of 20 hours per week.

The activity must have direct vehicular access from a public road that is normal and customary for ingress and egress by the public to the activity as well as adequate parking to accommodate public access.

The qualifying activity must be in a permanent building with an indoor restroom, telephone, running water, functioning electrical connections, adequate heating and permanent flooring.

The business must have an on-premise sign, displays, or other devices identifying the business.

The qualifying activity may not be an agricultural, forestry, ranching, grazing, or farm producing operation.

If qualifying activity is a mobile home, all wheels and axles and springs must be removed and secured permanently on piers, pad or foundation.

The activity holds a current, valid business license issued by a local, county or state government which authorizes the business to operate from that location and is attached to this application including a photo of the business.

If a business license is unavailable, please explain: