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 #:

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

NEW PERMIT applications also include one initial permit fee for total sign face square footage.

☐ 32 sf or less ($10)	☐ 33 – 375 sf ($50)	☐ 376 – 672 sf ($100)	☐ 673 – 1344 sf ($150)

TOTAL $

SIGN OWNER/APPLICANT CERTIFICATION

I agree to abide by the provisions of this application, the Montana Outdoor Advertising Act (Mont. Code Ann. §§ 75-15-101-134) and Montana Outdoor Advertising Regulations (Mont. Admin. R 18.6.202-264). Failure to stay in compliance with all local sign regulations may result in revocation of an issued sign permit. Providing incorrect or false information whether unintentional or not may also result in permit revocation. For sign regulations: upon approval of the new location, the former location is unavailable. The permit number transfers to the new approved location.

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)

DESCRIPTION OF SIGN STRUCTURE

Style:	☐ Single Face	☐ Double Face	☐ Wall Mount	☐ Side by Side	☐ V-Shaped
☐ Stacked	Will stacked be Double Face:	☐ Yes	☐ No
☐ Electronic Billboard	☐ Yes	☐ No

Sign Post	☐ Steel	☐ Wood	☐ Monopole	☐ Lighted	☐ Yes	☐ No
☐ Other

DIMENSIONS

Insert sign width (W), height (H) including border & trim, and distance (D) between signs for a Side by Side or Stacked structure.

Sign Width (W)
Sign Height (H) including border & trim
Distance between sign for Side by Side or Stacked Structure
Total Height of sign structure
HAGL: Height of bottom of sign to ground level – measured at right angle, road surface to sign
Sign face square footage

W	W	W
H	H	--------------------	H
D
Single Faced	Side by Side / V Shaped / Double Faced

W	W
H	H
D	D
W	W
H	H
Stacked (front)	Stacked (back if applicable)

Signs may not be erected or maintained that exceed 672 square feet per face in area, including border and trim but excluding base or apron, supports, and other structure members. Signs may not exceed 48 feet in length. The maximum height of the sign structure, including the sign face, is 30 feet, measured at right angle from the surface of the roadway at the centerline of the interstate or primary highway. No more than two facings visible and readable from the same direction on the main-traveled way may be erected on any one sign structure. Whenever two faces are so positioned, neither may exceed 325 square feet. Montana Code Ann. § 75-15-113(4). The name of the Sign Owner must be displayed on the Sign Structure.

DETAILED DRAWING OF PROPOSED SIGN LOCATION

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. Indicate the distance to the next permitted sign and include in your drawing below. 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 extent of the property used to qualify an activity is the active area of the business, including its buildings, parking area and incorporated landscaped area, but does not include vacant land, land used for unrelated activities, driveways or land that is separated by other ownerships or roadways and must be located within 660’ of the outer edge of the right of way. The measurement is taken at a right angle from the activity to the edge of the right of way. This measurement from right of way edge to proposed sign location must be 600 feet or less.

If the activity is over 660 feet from the nearest edge of the highway right of way and is accessed by an approach and road from the highway, any sign, landscaped area or appurtenance associated with the activity adjacent to the highway approach and access road shall not qualify the activity.

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 abide by the provisions of this application and comply with the Montana Outdoor Advertising Act (Mont. Code Ann. §§ 75-15-101-134 and Montana Outdoor Advertising Regulations (Mont. Admin. R. 18.6.202-264. The Agent for the applicant attests that he/she has authority to contract in this matter and the landowner hereby acknowledges that the applicant has consent to erect and maintain the proposed advertising sign on its property. The applicant, landowner, and their assigns further acknowledge and grant the Montana Department of Transportation (MDT) the right to enter the property upon which the sign is or will be situated for the purpose of inspecting the sign and removing illegal signs pursuant to. (Mont. Code Ann. 75-15-131. We further acknowledge that upon relinquishment of an existing permit, we must remove the permit plate and return it to MDT and remove the sign structure.)

We also agree to hold MDT harmless and indemnify it for any damage caused either directly or indirectly by the erection and maintenance of this 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). To the extent the landowner is represented by an agent, satisfactory documentation is required of the agent's authority. A dated statement of lease must include a right of entry in favor of and acceptable to MDT for the purpose of inspecting the sign site and 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: