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1.
Step One
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2.
Applicant Information
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3.
Site Plan Information
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Step One
Date of Request
Date of Request
Address of Project
Street Address, City, State, Zip Code
Description of Request
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Applicant Information
Property Owner/Tenant
Contact Name
*
Address of Owner
*
Street Address, City, State, Zip Code
Telephone No.
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Fax No.
Email Address
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Site Plan Information
Site Acreage
Parcel Identification
Subdivision Lot & Parcel # and/or Tax Map Designation
Current Zoning
Existing/Proposed Square Footage of Structure(s)
Name of Subdivision
(if applicable)
Proposed Land Use Activity
Contract Purchaser
(name, address and approval if applicable)
Actions Taken/Date
Approved (as consistent with 286-318.22)
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Conditions (if any)
Reason
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