APPENDIX C: APPLICATION FOR SPECIAL USE PERMIT

VILLAGE OF BRIGHTON               Application for

206 S Main St                        SPECIAL USE PERMIT

PO Box 458

Brighton, IL 62012

NAME OF APPLICANT: ____________________________________________________   Date: _________________

PROPERTY OWNER: _______________________________________________________

Property Address: ___________________________________________________________   Zoned: ________________

Parcel ID Number: _____________________________________________

   Owner’s Mailing Address: __________________________________________________________________________

   Owner’s Phone Number: __________________________________________________

Leasing Agency: _____________________________________________________________

   Agency Address: ________________________________________________________

   Acting Agent: ___________________________________________________________

   Phone Number: __________________________________________________________

Purpose of Permit: _____________________________________________________________________________________

_____________________________________________________________________________________________________ _____________________________________________________________________________________________________

I understand that this application shall be referred to the Zoning Board for a public hearing. A report will be sent to the Village Board for review.

I understand that I am personally liable for the costs necessary to provide the public and adjacent property owners with notice of the hearing on this application.

I understand that any permit granted pursuant to this application may be subject to such protective restrictions, as the Village Board my deem necessary.

                                          __________________________________________

                                             Signature of Applicant or Acting Agent