TOWN OF
LAND USE CHANGE/CONDITIONAL USE APPLICATION
Filing Fee: $250.00, payable to Town of
Filing Deadline: Last Friday of the month to be on the Plan
Commission agenda the next month
Instructions:
Please fill out all information below that applies to your request.
Applicant: _________________________ Address:
___________________________
City/State/Zip Code: ____________________________________________________
Landowner: ________________________ Address:
___________________________
City/State/Zip Code: ____________________________________________________
Applicant Phone: (___)_______________ Landowner
Phone: (___)_______________
This application is for:
_____ Conditional use
Acreage of proposed lot(s): ______________
Section ____ Town ____N Range ____E ____1/4 of the ____1/4
Does this request involve any proposed land
division? _____Yes _____No
Current zoning district of land: ____________
Requested zoning district: __________ for the
proposed use(s) of: _______________
______________________________________________________________________
Requested conditional uses(s):
_____________________________________________
_______________________________________________________________________
Reason for the
request:
___________________________________________________
Applicant(s) Signature: _____________________________
Date: _________________
Landowner(s) Signature: ___________________________
Date: _________________