Name:                                                                                 Date:

 

Address:                                                                             Phone:

 

Address of Property in Question:                                          Present Zoning of Property:

 

Name of Property Owner(s):

 

Present Zoning of Neighboring Properties to the:

North                             South                             East                         West

Parcel ID # Map #

 

Type of Special Use Requested:

 

Fire & Smoke Alarms: Yes_______No______ Handicap availability: Yes______No______

Site Plan including, all structures, well, septic, parking, walkways, fences, etc., must be attached.

I hereby give permission for the members of the Planning Commission to access and inspect the property in question for the purpose of gathering information to make an informed decision on this special use request.

Property Owner Date

 

THE INFORMATION CONTAINED WITHIN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND SUBMITTED TO THE PLANNING COMMISSION FOR THEIR REVIEW. I REALIZE THAT ANY INFORMATION THAT I SUPPLY THAT IS NOT CORRECT COULD VOID ANY DECISION BY THE BOARD. I ALSO ACKNOWLEDGE THAT THE SPECIAL USE IS NOT TRANSFERABLE AND IF ANY OF THE CONDITIONS ARE NOT MET THE SPECIAL USE PERMIT WILL BECOME VOID.

Applicant Signature                                                                     Date