1.) Applicant
NAME: ___
MAILING ADDRESS:
TELEPHONE:
OWNER: (CHECK ONE) ___YES ___NO
2.) Property Location: ___
3.) Legal Description: Lot(s)___ Block(s)___ Subdivision
4.) Existing Use of Property:
5.) Zoning: ___
6.) Give a brief explanation of reason for request: _____
Signature ___ Owner
Signature _____
<div style="text-align: center;"><img src="imgs/img_in_image_box_5_57_768_86.jpg" alt="Image" width="96%" /></div>
Date
$50 Fee Received by: ___ Date Received ___
Please attach to this “Application for Development Review Committee Meeting” the Following items: