Application for Conditional Use Permit - Village of Carroll, Ohio

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VILLAGE OF CARROLL
PLANNING AND ZONING BOARD

Application #:

Date Filed:

The undersigned request a Conditional Use Permit for the use specified below. Should this application be approved, it is understood that is shall authorize only the specific use described in the application any conditions or safeguards required by the Board. If this use is discontinued for more than six (6) months, this permit shall automatically expire.

1. The building, structure or premises for which Conditional Use Permit is requested is as follows:

Address:

Lot No.

Addition:

Parcel No.

Current Zoning Classification:

2. Name(s) of Property Owner(s)

Address of Property Owner(s):

Telephone No.

3. Name(s) of Occupant(s) of Property:

4. Present Use of Property (Include All Uses on Site):

6. Legal Description of Property (as on record in the Fairfield County Recorder's Office):

68 Center St PO Box 367 Carroll, Ohio 43112-0367 740-756-4031 fax: 740-756-4611

7. 7. List below the names and mailing addresses (as they appear on the current tax list of the records of the Fairfield County Auditor) of all property owners within two hundred (200) feet of, contiguous to and directly across the street from the subject property. If available, also provide the telephone numbers of these property owners.

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

Owners Name

Mailing Address

Telephone Number

8. Attach to this application all of the following documents:

a) Site map or plan showing property lines, streets, existing buildings drawn to approximate scale, in sufficient detail to illustrate the proposed action;
b) A written narrative detailing the following facts and conditions: How the proposed rezoning will affect adjacent and proximate properties.

9. A fee for application processing, as established by the Carroll Village Zoning Board: $

10. I hereby certify, to the best of my knowledge and belief, that the foregoing statements and all documents attached hereto in support thereof, are true and accurate.

Name of Applicant(s) (Print)

Telephone Number of Applicant(s)

Applicant(s) is/are:

Owner(s)

Occupant(s)

Owner’s Agent

Other

Witness:

Applicant

(Printed Name)

Applicant

68 Center St PO Box 367 Carroll, Ohio 43112-0367 740-756-4031 fax: 740-756-4611

TO BE COMPLETED BY PLANNING AND ZONING BOARD

Date of Advertisement:

Date of Meeting to Consider Request:

Action of Planning and Zoning Board:

Date of Action:

Authorized Signature

68 Center St PO Box 367 Carroll, Ohio 43112-0367 740-756-4031 fax: 740-756-4611