MDT Use Only Permit #: ______________ ☐ Approved ☐ Denied Date: _________________
OAC Agent
OAC Supervisor

LOCAL TRANSIT AGENCY (Company Name)

Name:

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

Email:	Phone:	Permit #:

LOCATION ON HIGHWAY RIGHT-OF-WAY

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:	/

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.

☒ 24sf or less $10.00

TOTAL DUE $160.00

TRANSIT COMPANY/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.

For sign relocations: upon approval of the new location, the former location becomes revoked. The permit number will transfer to the new 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
☐ Other

Sign Post	☐ Steel	☐ Wood	☐ Concrete
☐ Other

DIMENSIONS

Insert sign width (W), height (H) including border & trim.

Sign Width (W)
Sign Height (H) including border & trim
Sign face square footage

W
H
Single Faced

Per ARMS 18.6.236(6)

Shelter advertising signs may only be placed on the interior or exterior of the side shelter panel farthest from incoming traffic, perpendicular to the road. The designated shelter panel may only display 1 sign on the interior, and 1 sign on the exterior, for a limit of 2 signs per shelter.

(7) Bus bench advertising signs may only be placed on the front or rear of the bench back, excluding supports. The bench back may only display one sign on the front and one sign on the rear, for a limit of two signs per bench. Each sign must not exceed 2 feet in height and 8 feet in length, for a maximum of 16 square feet. One transit advertising permit is required per bus bench.

(8) Spacing requirements for a transit advertising permit include:

(a) permits must be located at least 500 feet from another transit advertising permit, on the same side of the controlled route unless the applicant justifies a lesser distance, which must be approved by the Department’s Outdoor Advertising Control program; and

(b) a transit advertising permit will not be considered in determining the spacing required between other non-transit permitted off-premise advertising sign.

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:

ENCROACHMENT REQUIREMENTS

Per ARM 18.6.236

(2) Shelters or benches eligible for transit advertising permits must be located within government owned right-of-way, and must meet the following requirements:

(a) the applicant must be a local transit agency or government entity; Private applicants are not eligible for transit advertising permits.

(b) an application must include a Department-issued encroachment permit or the equivalent local government permission allowing the shelter or bench to be located within right-of-way. A copy must accompany the transit advertising permit application.

(c) an application must include local government approval on a form provided by the Department. Applicants must comply with all applicable local regulations; and

(d) the applicant may submit multiple shelter or bench transit advertising permit applications simultaneously, and only 1 inspection fee is required for the applications within the same applicant’s jurisdictional area.

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 #