CITY OF SHELBY, RICHLAND COUNTY, OHIO
APPLICATION NO.
APPLICATION FOR A CONDITIONAL ZONING CERTIFICATE
(File in Duplicate)
THIS APPLICATION, WHEN PROPERLY APPROVED, SHALL CONSTITUTE A CONDITIONAL
ZONING CERTIFICATE.
NAME OF APPLICANT
ADDRESS
PHONE NUMBER
LOCATION OF LAND FOR WHICH CONDITIONAL CERTIFICATE IS SOUGHT
ZONING DISTRICT
SECTION OF ORDINANCE INVOLVED
Date Applicant Signature
ATTACH A SITE PLAN SHOWING:
BOUNDARIES OF PROPERTY
ABUTTING STREETS OR ROADS
EXISTING STRUCTURES
PROPOSED STRUCTURES
ACTION OF BOARD OF ZONING APPEALS
CONDITIONAL ZONING CERTIFICATE IF GRANTED/DENIED.
CONDITIONS (IF ANY) UPON WHICH CERTIFICATE IS GRANTED:
Date President, City Planning Commission
City of Shelby