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PORT SHELDON TOWNSHIP
SPECIAL USE APPLICATION
FILING FEE $400.00 (if site plan not required)
A SITE PLAN AND BUILDING PLANS MUST BE SUBMITTED
WITH THIS APPLICATION.
TO THE PLANNING COMMISSIO C/O The Zoning Administrator. Application is
hereby made pursuant to the provisions of the Zoning Ordinance.
Name of Applicant
_________________________________________Phone____________
Mailing Address of
Applicant_____________________________________________________
_____________________________________________________________________________
Address of Property In
Question__________________________________________________
Parcel Number of Subject Property____________________________________Zoning______
Applicants Interest in Property____________________________________________________
Name of
Owner________________________________________________________________
Address of
Owner_____________________________________________Phone___________
Present use of Structure/Premises_________________________________________________
Proposed Use of
Structure/Premises________________________________________________
Size of Existing/Proposed
Structure________________________________________________
Description of Existing/Proposed Structure__________________________________________
_____________________________________________________________________________
Describe the nature of your
request_______________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
If there has been a previous request involving the existing
structure/premises, state the date of filing, character of request and
disposition of same.____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________________
Signature of Applicant or Agent
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