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Special Exception Permit Application

  1. Street Address, City, State, Zip Code
  2. Application Information
  3. Street Address, City, State, Zip Code
  4. Street Address, City, State, Zip Code
  5. Street Address, City, State, Zip Code
  6. Street Address, City, State, Zip Code
  7. Statement*
  8. Site Plan Information
  9. Subdivision Lot & Parcel # and/or Tax Map Designation
  10. (if required)
  11. Attachments
  12. Attachments*
    Check all applicable below:
  13. (if required)
  14. Please email attachments to to include with your submission if error occurs attaching files above.
  15. Adjoining Property Owners
    All adjacent property owners shall be listed. Adjacent property owners include all property across from roadways, watercourses, railroads, and/or municipal boundaries. The names and addresses below are those of adjacent property owners as listed in the tax records of the City Assessor and County Assessor if applicable.
  16. Questions
  17. A conceptual plan needs to be filed with the application. The conceptual plan shall include, not limited to, a scaled drawing depicting the parcel showing property lines, the location of all existing structures with measured setbacks, location of proposed structures with measured setbacks, any environmental issues (i.e.: limits of wetlands, RPA 100’ buffer, RMA, Flood Plain), location of any historic resources, and location and dimensions of what is being considered for the special exception permit.
  18. Leave This Blank:

  19. This field is not part of the form submission.