F: 570-839-0981
1361 Pocono Boulevard, Suite 100
Mount Pocono, PA 18344
1361 Pocono Boulevard, Suite 100
Mount Pocono, PA 18344

Forms & Documents

On this page you will find the forms which you need to conduct business with Mount Pocono Borough. If you do not find what you are looking for, please contact the Mount Pocono Borough for assistance.

NOTE
Online forms REQUIRE an email address.
Downloadable PDF forms will be coming soon.

Alarm Permit Application

Name(Required)
Address(Required)

Description of property where alarm will be or has been installed.

Address
Installer
Installer's Name(Required)
Installer's Address(Required)

Person or firm to be contacted in the event of alarm activation

Address(Required)
PERSON OR FIRM NAMED MUST BE AVAILABLE TO DEACTIVATE OR SHUT OFF ALARM WITHIN A REASONABLE TIME AFTER BEING NOTIFIED BY THE POLICE

Application for Appointment

Name(Required)
Date of Application(Required)
Address(Required)

Driveway Permit Application

Date(Required)
Property Owner's Name(Required)
Address(Required)
Aprrox. Start Date of Work(Required)
End Date(Required)
Application shall be accompanied by an accurately scaled drawing of the proposed access driveway showing all pertinent details (drain pipes, ditches, property lines, width, type of surface, etc.)

The terms and conditions embodied in this permit require the permittee to complete this work by the date specified in the permit. Where the permittee fails to comply with the condition as to the completion of the work by the time specified, the following rules will govern:

1. FAILURE TO START WORK BY THE DATE SPECIFIED: This permit will be cancelled unless the permittee desires an extension of time, in which case a supplemental permit may be issued.

2. WORK STARTED AND NOT COMPLETED BY THE SPECIFIED DATE: The permittee will notify the Borough prior to the expiration of the allotted time, of inability to complete the work on or before the date specified and request an extension of time. Such request shall be accompanied by the prescribed fee.

Emergency Road Opening Permit Application

Date(Required)
Name(Required)
Address(Required)

Purpose of Application: Emergency Road Opening Permit

Property Address #1
Date Work Completed #1
Property Address #2
Date Work Completed #2
Property Address #3
Date Work Completed #3

This application is under and subject to all the conditions, restrictions and regulations prescribed by the Mount Pocono Borough

Name of Applicant(Required)

Facility Usage Request

Today's Date(Required)
Name of Contact(Required)
Date 1
Time 1
:
Date 2
Time
:
Date 3
Time
:
Date 4
Time
:
Date 5
Time
:
Community Room Policies and Procedures

General Guidelines
The Mount Pocono Borough Community Room is designated primarily to provide a forum for non-profit community groups or organizations who organize for educational, cultural and civic purposes. Celebratory gatherings, private parties, catered events, for-profit events and political meetings or functions are prohibited.

No Endorsement
Use of any Borough facility shall not constitute Borough endorsement or viewpoints expressed by participant in any program occurring thereat. No adverisement or announcement implying such endorsement shall be permitted.

Equal Opportunity
All non-Borough activities taking place in any Borough facility must be open to all citizens, regardless of age, sex, race, religion, national origin or physical handicap. To the extent necessary, it shall be the responsibility of the group hosting an activity to provide any and all reasonable accommodations for persons with disabilities to the extent required by the Americans with disabilities Act. Restrictions
- Room reservation request may be made in person, by telephone, fax or completed from the Borough's website: however, notification by a staff member and completion of the COMMUNITY ROOM REQUEST FORM is required at the community room location to confirm any reservation requests.
- Organizations using Borough facilities shall not use the Borough address as their mailing or registered address or direct calls regarding any activity to the Borough telephones.
- Attendance limit for the community room shall be 40 people.
- Meetings involving persons under the age of 18 shall be chaperoned.
- Groups are responsible for cleanup. Ali trash shall be placed in the receptacles prior to the end of their activity and lights have been turned off.
- Groups must replace keys to the lockbox and ensure that facility doors are locked after exiting.
- Groups may not charge an admission fee for any event held in any Borough community room.
- Groups may not attach or affix any sign, banner or flyer to any wall, ceiling or other piece of Borough property.
- No group may store any item on Borough property without written approval of the Board of Supervisors.
- A Group’s use of the community room shall not interfere with normal Borough activities or the activities of Borough tenants.
- Activity and noise levels in the community room during meetings must not disrupt or disturb regular tenant activities.

Miscellaneous Policies
- Any Group using a Borough community room shall indemnify and hold harmless the Borough, its officers, consultants, elected officials and employees from and against any loss. liability or damage arising out of, as the result of, or in connection with said Group’s use of such community room, including all costs of defending any claim arising as a result-thereof.
- Liability insurance in the amount of $1,000,000 shall be required for groups of 5 or more. Proof of insurance must be provided to the Borough no less than five days before such groups’ use ofthe community room.
- The Borough shall assume no responsibility for any item, material or equipment any group or individual may leave in a community room at the conclusion of any group’s use thereof.
- It is the responsibility of the Groups applicant to be present at the event and ensure all guidelines are followed.

Revocation or Refusal of Authorization for Use of community room
There may be times when the use of Borough facilities for community room purposes is in conflict with the basic role of the Borough in servicing the public In such rare instances, the are privilege of using Borough facilities may be revoked. The following criteria in nature only, and are not intended to be exclusive.
- Whether the planned meeting is, or meetings by the group planning the meeting have been, conducted in a noisy, disorderly or inflammatory manner (as opposed to a neat, orderly and courteous manner).
- Whether the planned meeting is so confrontational or inflammatory in nature that it is likely to embroil other groups or the general public in open conflict, thereby impacting normal Borough operations.
- Whether the planned size of the meeting threatens the personal safety of the public, Borough facilities or Borough staff in that it may impact the flow of traffic or create a hazardous degree of congestion.
- Whether the activities of the group impact the security of Borough facilities.
- Whether users abide by the policies governing use of the community room.
- Whether the anticipated parking demands of the meeting exceed on-site parking availability.


I have read and understand the information on the Community Room Use Policy (above).
Digital Signature of Applicant(Required)
Date(Required)

Field Use Request For Multiple Dates

RULES AND REGULATIONS FOR USE OF Borough FIELDS

The Mount Pocono Borough ball fields are located on Rt. 423 in Tobyhanna, across from the Tobyhanna Army Depot.

The following rules and regulations must be adhered to:

Groups are to utilize only the field to which they have been assigned.

Groups who have reserved and been assigned a field will be given a preference over groups who do not have reservations.

Mount Pocono Borough groups/organizations will be given preference over non-Borough groups/organizations.

Leagues and organizations must have a current copy of their certificate of insurance, with Mount Pocono Borough listed as an additional insured, on file at the Mount Pocono Borough office.

Trash and litter are to be placed in proper containers.

Open fires, firearms and/or fireworks are not permitted.

Alcoholic beverages and/or illegal substances are not permitted.

Changing the integrity of any field is strictly forbidden.

Leagues or groups who hang signs or banners at the fields must remove them at the end of the day’s play.

Leagues or groups who wish to hang signs or banners at the fields for longer than the day’s play must seek written permission from the Parks & Recreation Commission.

Violent and obnoxious behavior will not be tolerated. This includes but is not limited to: fighting, inappropriate language, loud music or intrusion on other park patrons.

Domestic pets, with the exception of those required for handicapped assistance, are not permitted in the park.

Groups or individuals requesting permission for field use are responsible for any damage to the field or equipment done by members of the group.

Nails, coat hooks, tacks, duct tape or attachments of any kind are not permitted to be made to any of the structures or natural habitat.

The Park officials have the authority to act upon and enforce specific situations not covered above. All of the above shall be enforced by the Pocono Mountain Regional Police Department.

Failure to comply with all park rules and regulations could result in banishment from the park and / or legal action.
Address
Name of Contact Person(Required)
Dates Requested
1. From
1. To
2. From
2. To
3. From
3. To
4. From
4. To
5. From
5. To
I agree to adhere to the rules and regulations listed below and take full responsibility for the actions of the above group / organization.
Digital Signature(Required)
Today's Date(Required)

Right-to-Know Request Form

Standard Right-to-Know Law Request
Good communication is vital in the RTKL process. Complete this form thoroughly and retain a copy; it is required should an appeal be necessary. You have 15 business days to appeal after a request is denied or deemed denied.
Date of Request(Required)
Person Making Request(Required)
Address(Required)

Permit Application

Sanitation Bill Paid (If Applicable)
Date
The purpose of this form and of other materials supplied by the Borough of Mount Pocono is to assist applicants in meeting the requirements of Borough ordinances and regulations

Frequently, requirements of other governmental agencies and authorities must also be met. Applicants are responsible for determining all of the requirements that they must fulfill for obtaining copies of relevant ordinances and regulations of the Borough of Mount Pocono and of all other authorities having jurisdiction and of meeting all of the requirements contained therein.
Name of Appicant(Required)
Address of Applicant(Required)
It is understood that any permit will not grant any right or privilege to erect any structure or to use any premises herein described by the Borough of Mount Pocono zoning ordinance.

Supplement sheets applicable to the permit being applied for must be attached to this cover sheet. It is incomplete without a supplement.

Request to be placed on an Agenda

Name(Required)
I am...(Required)
enter the name of your business or organization
Please acknowledge and accept our Code of Conduct(Required)

Emergency Road Opening Permit Application

Date(Required)
Name(Required)
Address(Required)

Purpose of Application: Emergency Road Opening Permit

Property Address #1
Date Work Completed #1
Property Address #2
Date Work Completed #2
Property Address #3
Date Work Completed #3

This application is under and subject to all the conditions, restrictions and regulations prescribed by the Mount Pocono Borough

Name of Applicant(Required)

Sewer Hook Up Application

Sewer connection permit application for permit to build and connect building sewer to sanitary sewer system.

The undersigned hereby makes application for permission to construct a building sewer, and to connect the herein designated property with the sanitary sewer system of coolbaugh township.
Owner's Name(Required)
Location of property(Required)
Owner's Address (if different from above for billing purposes)
By applying for this permit, the undersigned agrees:

1. To accept and abide by all Ordinances of Mount Pocono Borough, and any amendments thereto as well as all Rules and Regulations of the Township concerning the sanitary sewer system constructed by the Township.

2. To maintain the Building Sewer and the Lateral between the building and the sanitary sewer system constructed by the Township at no expense to the Township at no expense to the Borough.

3. To notify the Township Inspection Office in writing at least 72 hours prior to the date and time when you or your plumber of plumbing contractor plan to commence construction of the Building Sewer.

4. To notify the Township Inspection Officer in writing 24 hours prior to the time when the connections are anticipated to be made to the connections are anticipated to be made to the Lateral in order that the Township Inspection Officer can provide a schedule for inspection.
Signed (Complete Name)(Required)
Name (Owner or Applicant)(Required)
Date Received(Required)

Short Term Rental Application

Owner Information

Name(Required)
Address(Required)
Emergency contact (person, agency or firm-must provide 24-hour contact number, able and willing to come to and be present at the property within two (2) hours following notification to address any issue, and act as legal agent for the owner)
Emergency Contact's Name(Required)
Emergency Contact's Address(Required)

Property Information

Property Address
Total overnight guests shall not exceed two (2) per bedroom plus four (4) additional persons per residence. Infants under two (2) years of age shall not count towards the limit of overnight occupants)
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      FEES
      Initial Application/InspectionFee-$200 AnnualLicenseRenewalFee-$150
      Reinspection Fee-$40(for any corrections needed found during inspection, or any revision to the property)
      Make checks payable to COOLBAUGH TOWNSHIP

      **By signing this Application, I certify that all facts set forth within the Application and all accompanying documentationare true and correct. This Application is being made by me to induce official action on the part of Mount Pocono Borough, and I understand that any false statements made herein are being made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities*
      Digital Signature(Required)
      Date(Required)

      Sign Permit Application

      Instructions

      Applications for sign permits shall be submitted to the Zoning Officer and shall contain or have attached thereto the following:

      1. The names, addresses and telephone numbers of the applicant, the owner of the property on which the sign is to be erected or affixed, the owner of the sign and the person affixing the sign.

      2. The location of the building, structure or zoning lot on which the sign is to be erected or affixed, including the tax identification number or property identification number.

      3. A sketch plan of the property involved, showing accurate placement thereon of the proposed sign. The location for a new freestanding sign shall be clearly identified by a white stake(s) visible above ground line at each location at which a support pole will be embedded in the ground.

      4. Two blueprints or ink drawings of the plans and specifications of the sign to be erected or affixed and method of construction and attachment to the building or in the ground. Such plans and specifications shall include details of dimensions, color, materials and weight.

      5. If required by the Zoning Officer, a copy of stress sheets and calculations prepared by, or approved by, a registered structural engineer, licensed in Pennsylvania, showing that the sign is designed for dead load and wind pressure in any direction in the amount required by this and all other applicable ordinances of Mount Pocono Borough.

      6. The written consent of the owner of the building, structure or property on which the sign is to be erected or affixed.

      7. Such other information as the Zoning Officer may require to determine full compliance with this and other applicable ordinances of Mount Pocono Borough. 8.If the work authorized under a sign permit has not been completed within 90 days after the date of issuance, the permit shall become null and void, unless otherwise extended by the Zoning officer for a single additional 90 day period.

      8. Within 10 working days of completion of approved work related to a permitted sign, the permitee or sign contractor shall notify the Zoning Officer that the sign is ready for a final inspection. The Zoning Officer shall conduct the final inspection for the purpose of verifying that the sign is in compliance with the requirements of the permit and all other provisions of applicable ordinances of Mount Pocono Borough.

      9. Failure to notify the Zoning Officer within 10 working days of work completion that the sign is ready for inspection shall result in the requirement that an additional fee as established from time to time by resolution of the Board of Supervisors of Mount Pocono Borough be paid.

      10. Failure to obtain a satisfactory inspection within 30 days after completion shall render the permit invalid. The applicant will be required to reapply for a permit or remove the sign or sign structure.

      If you should have any questions or need clarification regarding the above instructions, please contact the Zoning Officer prior to submitting the application. Any discrepancies can result in a delay of the application’s approval.
      Date(Required)
      Address(Required)
      Owner / Lessor Digital Signature(Required)

      Contractor Infomation

      Contractor's Address(Required)
      Date Work Will Begin(Required)
      Date Work Will End(Required)
      Contractor's Digital Signature(Required)

      Property

      Property Address(Required)
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            Applicant Digital Signature(Required)

            Tenant Registration

            Lessor / Lessee Statement

            Property Address(Required)

            Lessee Information

            Lessee #1 Term of Agreement (start date)(Required)
            Lessee #1 Term of Agreement (end date)(Required)
            Lessee #2 Term of Agreement (start date)(Required)
            Lessee #2 Term of Agreement (end date)(Required)

            Names of children or other individuals who will reside with the lesse

            I (We) understand that I am to notify Lessor and Coolbaugh Township Zoning Office of any changes to the occupancy of this premises within five days of change.

            I (We) verify that the facts set forth in this application are to the best of my (our) knowledge, information and belief. This verification is made subject to the penalties of Section 4904 of the Crimes Code (18 Pa. C.S. §4904) relating to Unworn falsification to authorities.
            Date(Required)
            Date(Required)

            Trash Bulk Item Pickup

            Name(Required)
            Property Address(Required)
            NOTE: You are limited to only two items

            UCC Board of Appeals

            Uniform Construction Code (UCC) Appeals Board Application
            This form may be used to file an appeal, seek a variance or an extension of time. When variances are requested, as many variances as may be needed may be sought via this application. Once this application has been submitted, no changes may be made, and any additional variance request must be filed via a separate (new) application.

            Construction Site

            Tenant Name(Required)
            Tenant Address(Required)

            Applicant (Contact Person)

            Contact Person(Required)
            Address(Required)

            Application One: Appeal of Building Code Official (BCO) Decision

            Date of Decision
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              Application Two: Extension Of Time Request

              Compliance Date Requested For Time Extensison(Required)

              Application Three: Request for Variance(s)

              Please provide allof the following information for each variance requested:(Failure to provide sufficient information will result in the return of your variance request(s) and delay the Board’s consideration of your request(s).)

              Wedding Request Form

              Name of Partner 1(Required)
              Name of Partner 2(Required)
              Address(Required)
              Date Of Wedding(Required)
              Address Of Wedding Venue
              Please enter a number from 1 to 9000.
              Date Of Marriage License Expiration?(Required)

              Zoning Application Shed, Deck, Patio, Pool

              Today's Date(Required)
              Physical Address of Property(Required)
              (if applicaple)
              Property Owner's Address(Required)
              If the Applicant is the same as the Property Owner then you can skip the section below.
              Applicant's Name
              Applicant's Address
              Option #1
              Option #1
              Option #2
              Option #2
              Option #3
              Option #3
              Option #4
              Option #4
              Option #5
              Option #5
              Option #6
              Option #6
              Option #7
              Option #7
              Option #8
              Option #8
              Option #9
              Option #9
              Option #10
              Option #10
              Option #11
              Option #11
              Signature of Applicant(Required)

              Establish a Use / Change of Use

              Date(Required)
              Physical Address Of Property:(Required)
              (if applicable)
              If “no”, then a signed consent letter from the property owner, allowing application for this use must be included.
              Accepted file types: doc, docx, pdf, Max. file size: 100 MB.
              Property Owner's Address(Required)
              Applicant's Address
              Business Name
              Business Address
              All new construction must comply with the PA Building Energy Conservation Act 222. This permit becomes null and void if construction is not started within six months of date of issue. This permit does not release owner from the requirements of any and all other Borough, State and/or Federal ordinances. A driveway permit may be required. All information submitted supporting this application sh all become part of the records of Mount Pocono Borough, cannot be returned and may be examined by the public any time during normal working hours of the Borough Zoning Office. I hereby certify that the above information is correct and true to the best of my knowledge and that I have also read and understand the above

              REMARKS: A Certificate of Use & Occupancy must be applied for and issued prior to occupancy of property and / or improvement.
              Digital Signature of Applicant *(Required)
              X