PROPERTY OWNER INFORMATION

NAME*

ADDRESS*

PHONE #*

EMAIL ADDRESS*

APPLICANT/BUSINESS OWNER INFORMATION

NAME*

ADDRESS*

PHONE #*

EMAIL ADDRESS*

IF THE APPLICANT IS DIFFERENT THAN THE PROPERTY OWNER, THE PROPERTY OWNER MUST PROVIDE WRITTEN AUTHORIZATION FOR THE PROPOSED USE OF THE PROPERTY

BUSINESS NAME*

CURRENT ADDRESS*

TYPE OF BUSINESS*

PROPOSED USE(S)*

ALL APPLICANTS ARE REQUESTED TO READ THE CITY'S CODE TO FAMILIARIZE THEMSELVES WITH THE REQUIREMENTS AND PROCEDURES PRIOR TO MAKING THE APPLICATION. THE STAFF MAY REQUIRE ADDITIONAL INFORMATION FROM THE APPLICANT OR THE OWNER.

GO TO WWW.CITYOFBLACKJACK.COM GOVERNMENT-MUNICODE-ZONING CODE

LEGAL DESCRIPTION OF THE PROPERTY AND PROPER MAILING ADDRESS*

A SITE PLAN (15 COPIES) DRAWN TO SCALE OF 100 FEET OR LESS TO 1 INCH MUST BE SUBMITTED FOR THE PROPERTY ON WHICH THE CONDITIONAL USE* IS TO BE LOCATED SHOWING BOUNDARY LINES, STREETS, EASEMENTS, ADJACENT PROPERTY OWNERS WITHIN 200 FT, DIMENSIONS, STRUCTURES, PARKING LOTS OR OTHER DEVELOPMENT, LANDSCAPING, INGRESS AND EGRESS FROM STREET, PROVISIONS FOR SANITARY AND STORM DRAINAGE, AND SUCH OTHER INFORMATION AS MAY BE PERTINENT TO THE PROJECT/SITE CONSIDERATION. THIS SITE PLAN SHOULD BE PREPARED AND SEALED BY A REGISTERED LAND SURVEYOR. *DETAILS ARE IN BLACK JACK ZONING CODE SECTIONS 270, 280, & 290, ETC..

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FOR OFFICE USE ONLY DO NOT WRITE BELOW THIS AREA

DATE APPLICATION RECEIVED

DATE SENT TO CITY'S ENGINEER

DATE RECEIVED FROM ENGINEER

P&Z MEETING DATE (IF APPLICABLE)

APPLICATION FEES & AMOUNT