Form M-950mpc - Land Use Questionnaire
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1
2LAND USE QUESTIONNAIRE
M-950MPC (10-14)
(Must be completed for low, medium and high volume driveway
applications only.)
www dot state pa us
Engineering District _________
(The Pennsylvania Municipalities Planning Code (Act 247 of 1968 as amended by Acts 67 and 68 of 2000), 53 P.S. §10101 et seq.,
requires state agencies such as the Department of Transportation to amend their permit review process. The Department of
Transportation shall consider, and under certain conditions may rely upon, comprehensive planning and zoning ordinances in their
decision-making process on applications related to infrastructure or facilities. All low, medium, and high volume driveway Highway
Occupancy Permit applicants are required to answer the following six questions. When completing the questionnaire, applicants
are encouraged to obtain assistance from the municipality and/or county. This questionnaire does not apply to Highway Occupancy
Permit applications for projects located in the City of Pittsburgh or the County of Philadelphia (these municipalities are not subject
to these requirements).
1. Does the county where your project is located have a comprehensive plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
2. Does the municipality where your project is located have a comprehensive plan? . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
3. Does the municipality or county where your project is located have a zoning ordinance? . . . . . . . . . . . . . . . . . .
YES
NO
4. Has the municipality where your project is located adopted a joint municipal zoning ordinance? . . . . . . . . . . . . .
YES
NO
5. Has the municipality where your project is located entered into a cooperative implementation agreement? . . . .
YES
NO
6. Is your project a permitted use by right, as specifically authorized in the applicable zoning ordinance,
or have you obtained formal zoning approval? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If YES, please respond:
a. If the project is a permitted use by right, what is the zoning classification for this property? ______________________
(Attach a copy of the applicable section(s) of the zoning ordinance and map.)
OR
b. If formal zoning approval(s) was required, what approval(s) did you obtain?
(Check all that apply and attach copy of zoning approval.)
Variance
Curative Amendment
Rezoning
Special Exception
Conditional Use
Under and subject to all the conditions, restrictions and regulations prescribed by the Pennsylvania Department of Transportation
(see in particular 67 Pa Code, Chapter 441), the applicant certifies that this questionnaire, information and documentation therein or
required by the Department is accurate, pursuant to 18 Pa. C.S. § 4904 relating to false swearing to authorities.
A
The Applicant is (an individual) (a partnership) (a corporation incorporated under the laws of ______________________________)
Signed On: _________________
Name of Applicant:_____________________________________________________________
D
E
Witness or Attest: ____________________________________
By :
____________________________________________
Title: ____________________________________
Title :
____________________________________________
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