Fee received Special Use No.
Receipt No. Date
REQUEST FOR SPECIAL USE
Notice to Applicant:
All blanks must be filled in, Decisions regarding a special
in entirety. Print or type. use may require up to 30 days
An incomplete or an illegible after the conclusion of the Request for a Special Use will public hearing.
not be accepted.
DO NOT WRITE IN THIS SPACE -- FOR OFFICE USE ONLY
Date of Request Date of Hearing
Date of Published Notice Newspaper(s)
Date Adjacent Property Owners Notified
Comments:
Action Taken: Special Use Granted
Special Use Denied
Special Use Dismissed
Continuance
DATA ON APPLICANT AND OWNER
Name Mailing Address Zip Code Tel. No.
Applicant
Owner
LOCATION OF PROPERTY IN QUESTION
At (location) Zoning District
(No.) (Street)
Between and
(cross street) (cross street)
Present Use
LEGAL DESCRIPTION OF THE PROPERTY
DESCRIPTION OF PROPERTY
Width of Lot Length of Lot
Total Square Feet
Proposed Use
REASONS FOR REQUEST FOR SPECIAL USE
NOTE: The following questions must be answered completely. If additional space is needed, attach extra pages to application.
l. Describe in detail the proposed use.
2. Yes No Are there other sites for the proposed use? Explain.
3. Yes No Is the proposed use contrary to the established land use
pattern?
4. Yes No Would the proposed use contribute to dangerous traffic
patterns or congestion?
5. Yes No Is the proposed use in the Public Interest? Explain.
6. Yes No Will the change adversely influence living conditions in the
vicinity?
7. Yes No Will property values in the vicinity be affected by change?
NAMES OF SURROUNDING PROPERTY OWNERS
Following are the names and addresses of surrounding property owners from the property in question for a distance of two hundred fifty (250) feet in all directions, and the number of feet occupied by all public roads, streets, alleys, and public ways have been excluded in computing the 250 feet requirement. Said names are as recorded in the office of the County Recorder of Deeds (or the Registrar of Titles of the County) as appear from the authentic tax records of this County.
NAME ADDRESS
I (we) certify that all of the above statements and the statements contained in any papers or plan submitted herewith are true to the best of my (our) knowledge and belief.
(signature) Applicant (date)
(signature) Owner (date)
(Ord. 80-0-24, passed l-12-81)