ZONING
PERMIT APPLICATION
Return to:
Cherry
Jack Ravenscroft
402-322-1856
This section to be filled out completely by
Applicant
1. The
undersigned hereby applies for a permit for: (check one)
___ New Construction
___ Alteration/Enlargement
___ House Moving
___ Double-Wide
Manufactured Home
___ Single-Wide
2. Legal description of property to be affected
by activity proposed:
_______________________________________________________________________________________
3. Proposed use of building to be affected by
the activity proposed:
_______________________________________________________________________________________
4. Size of building/addition: ______x______ Height in feet to top of roof: ______
5. Is the proposed activity located on a lot with an area of at least
2 ½ acres? ______Yes ______No
6. Number of single-family dwellings including
double-wide manufactured homes and single-wide mobile homes on the same section
as the building activity proposed in this application. ______
7. Do you own this land? ______Yes
______No (If no, landowner needs to sign application)
8. On the second page of this application,
sketch a site plan of the activity proposed in this application which indicates
all of the following:
a. Location
and size of the proposed building/addition.
b. The
location of all roads adjoining this property and the distance(s) from the
centerline of any road(s) to the point of the proposed building location
closest to said road(s).
c. The
distance from any buildings to property line(s) of property under different
ownership (if less than 300 feet).
d. The
distance to any confined or intensive livestock feeding use (if less than 4
miles)
e. The
location of other buildings within 300 feet of the building/addition proposed
in this application and the distance between these buildings and the proposed
building/addition.
f. The
location of any water well and sewage disposal system proposed to serve the
building/addition proposed and the distance between the well and the septic
tank and the tile field or other sewage disposal system.
g. The
location of any river, stream or intermittent stream within 300 feet of the
proposed building/addition and the distance to the proposed building/addition.
h. The
location of the driveway which will serve the building/addition proposed.
i. If the proposed use is a commercial,
industrial or public use, indicate the number and location of all parking
spaces, the location of loading areas and the proposed type, location, height
and size of any signs to be placed on the premises.
I hereby certify that I have the
legal authority to file this application, that I have completed and examined
this application and know the same to be true and correct. I further certify
that all provisions of law and other regulations governing the use proposed in
this application will be complied with, whether or not specified in this
application.
________________________________________ ________________________________________
Printed Name of Applicant Signature
of Applicant
______________________________________________________________________________________
Mailing Address of
Applicant
________________________________________ ________________________________________
Telephone Number Date
of Application
________________________________________ ________________________________________
Printed Name of Landowner
(if different than
applicant) Signature of Landowner (if different than applicant)
Sketch Site Plan Here:
This section to be filled out completely by the
Zoning Administrator
Application
is: ______APPROVED
______DISAPPROVED Reason(s) for
disapproval:_________________
__________________________________________________________________________________________
_____________________________________ _____________________________________
Signature of Zoning
Administrator Date
Zoning Permit
Number: __________