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FOR OFFXCE USE ONLY
CASE NO. 1= 1 l f~
DATE SUBMITTED IU' ~ L7E
CONDITIONAL USE PERMIT APPLICATION
(CHURCH)
Minimum Requirements
$150.00 application fee.
Ten (10) copies of site plan which includes requirements for site plan proposals as listed on attached sheet. This
site plan will be reviewed by Staff, after which ten (10) copies of revised site plan will be required.
Detailed explanation of proposed use including hours of operation, anticipated traffic, number of employees,
number of students, children, ages of children, church members, etc., as applicable.
If sign is planned for project, site plan should include sign elevation and details. If sign details are not
included on plans submitted with this application, any future sign may have to be considered as a separate
conditional use permit and all ofthe above requirements must be
feel.
Use Only 0 Site Plan Only 0 Site Plan and Use
NAME OF PROJECT X4A-2%:z5 V ,1,k
ADDRESS Ll 00 C_ d Y'PAss
LEGAL DESCRIPTION
APPLICANT (Primary Contact for the Project):
Name
Street Address S66 6 31&Z ~c& City f'~.~ ~✓k_ t
State I Zip Code E-Mail Address
Phone Number y Fax Number
PROPERTY OWNER'S INFORMATION:
Name ~ro Ker f"ok &e-K
Street Address o2 o 1+ City
State -7`71 Zip Code 7 E-Mail Address
Phone Number d'/ 7 - &f >'7 -'I V :?3 Fax Number
ARCHITECT OR ENGINEER'S INFORMATION:
Name
Street Address City
State Zip Code E-Mail Address
Phone Number Fax Number
OTHER CONTACTS (Please specify type of contact, i.e. project manager, potential buyer, local contact, etc.)
Name C?eNe--
Street Address city
State ! Zip Code -2;) E-Mail Address
Phone Number 4/a, Fax Number
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PRESENT USE OF PROPERTY
PROPOSED USE OF PROPERTY
CURRENT ZONING OF PROPERTY l
Total Acreage 2. S `19 Building Sq. Ft. Floodplain Acreage
VARIANCE(S) REQUESTED AND REASON(S)
NUMBER OF PARKING SPACES REQUIRED
NUMBER OF PARKING SPACES PROVIDED
APPLICATION WILL NOT BE CONSIDERED COMPLETE WITHOUT THE FOLLOWING INFORMATION
ADDRESSED:
State how the following issues will be addressed:
1. Approximate the distance to the nearest night clubs, restaurants, and retail commercial establishments.
2 Discuss the possible necessity for screening (fence or vegetation) between the subject site and adjoining residential
properties.
3. List all incidental uses along with hours of operation (including but not limited to school, day care, sports activities,
etc.)
C2 -
bV t'.o /1P~1:- ~b ~t.- ~~L~C~c~S • ~i f~i~►-~ C,~`P~E_ C..,/r.~.~ C~Y ci. /~~:+~/`7%i j✓ • j- c.e~ v
I verify that all of the information contained in this application is true and correct.
Signature of Owner, Agen or Applicant Date
oAforms\p1an\cupachur.dw