MHP/RCA Plan Review Form

Kandiyohi-Renville
Community Health Board

E-APPLICATION AND LICENSING

Developed By CPT

Ver 11/13/2023

Kandiyohi-Renville Community Health Board
2200 23^rd Street NE Suite 1080, Willmar, MN 56201
www.co.kandiyohi.mn.us — www.co.renville.mn.us
Kandiyohi County: 320.231.7800
Renville County: 320.523.2570
publichealth@co.kandiyohi.mn.us — rcph@renvillecountymn.com

Print
Blank
PDF

2024 MHP/RCA PLAN REVIEW APPLICATION

ESTABLISHMENT INFORMATION

Business Name:

Street Address:

City: State:

Zip:

Telephone (business):

Water Supply System: Municipal Private

Sewage System: Municipal Private

OWNER

Name:

Mailing Address:

City: State:

Zip:

Telephone:

Email:

Contact person for all plan review correspondence

Contractor Designer Owner Other

Applicant's Name:

Mailing Address:

City: State:

Zip:

Telephone:

Email:

Notices should be sent to: Owner Applicant

CONSTRUCTION DATES

Anticipated Start:

Anticipated Completion:

# of Mobile Home Sites:

# of Dependent Camp Sites:

# of Independent Camp Sites:

Fee: $

The Plan Review Fee is equivalent to the establishment's license fee. Fees must be submitted with this application.

Make checks payable to: Kandiyohi-Renville Community Health Board; mail to address above.

Review Kandiyohi-Renville Construction Guidelines for all construction requirements.

Blue prints of the grounds must be submitted. They must be drawn to scale and include: each lot, water source, toilet, showers, roads, sewage treatment system, park shelter, etc.

Failure to submit plans and appropriate fees for new construction or remodeling will not prevent the fees from being collected. In addition, any construction not meeting code will have to be corrected prior to opening.

Drop files here to upload
If form needs resubmission all files will be saved, but not shown
except in the case of session expiration

This is to certify that I am the individual who is the subject/business owner of the requested application.

This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.

I certify that the information provided on this application is accurate and complete.

Online Application Completed

ByDate