APPLICATION FOR REZONING

REQUEST FOR REZONING:

NAME OF APPLICANT:

PHONE NUMBER:

ADDRESS:

NAME OF PROPERTY OWNER:

LOCATION AND LEGAL DESCRIPTION OF PROPERTY: SEE ATTACHED DEED.

PRESENT ZONING OF PROPERTY:

PLANNED USE OF PROPERTY:

(Attach plans showing plot plan and off-street parking)

DOES THIS PROPERTY HAVE RESTRICTIVE COVENANTS:

HAS ANY REQUEST FOR REZONING FOR THIS PROPERTY EVER BEEN MADE BEFORE?

It is understood and agreed by the applicant, and permission is hereby granted to the Zoning Director for the inspections, investigations and/or evaluation reports by the proper agencies, pertaining to said property. In the event such investigation, etc., disclose this property does not meet the requirements for the proposed usage, then this request will be held in abeyance until such time as those requirements are met and/or evidence of such is submitted.

The above information is true, correct and complete to the best of my knowledge.

By signing below, I hereby certify and attest that the above information is true, correct and complete to the best of my knowledge.

APPLICANT SIGNATURE:

Clear

By signing below, I hereby certify and attest that the above information is true, correct and complete to the best of my knowledge.

PROPERTY OWNER SIGNATURE:

Clear