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2. Applicant Name
4. Applicant Address
6. Owner of Property
8. Address of Property
10. Phone Number
14. Legal Description of Property
16. Government Lot
18. Lot
19. Subdivision
21. Property Fire Number
22. Township
24. Lot Size
26. Present Use
28. Zoning District
30. Reason for Special Exception Request
34. Specific Information
    Address each of the following criteria, (attach additional pages as necessary).
36. Unnecessary hardship is present because...
38. Unique features on this property prevent compliance with the terms of the ordinance because...
40. A Special Exception will not be contrary to the public interest because...
44. Notarized Signature of Applicant or Agent
45. Date
    Date
47. Subscribed and sworn to before me.
    Subscribed and sworn to before me.
48. My Commission Expires
52. Plot Plan
    Please upload a plot plan.
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54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field