2. FEE $50
4. Property Address*
6. Lot*
7. Block*
8. Subdivision*
10. Tax Account*
11. Zoning*
13. Proposed Use*
15. Present Use*
17. Applicant Name*
18. Applicant Phone Number*
20. Applicant Address*
22. City*
23. State*
24. Zip*
26. I hereby certify that all information contained herein is true and correct.*
27. Date and Time*
    Date and Time

    Date and Time
29. Site Plan*
31. 1. Failure to submit the site plan to scale and with all required information may be grounds for denial of the request.
33. 2. A Specific Use approval is valid for one year unless a building permit is issued and construction is ongoing.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field