2. Property Address*
4. Legal Description*
6. Area in Acres*
8. Present Use*
10. Proposed Use*
12. Reason for Request*
14. Applicant Name*
15. Applicant Email Address*
16. Applicant Phone Number*
18. Applicant Address*
20. City*
21. State*
22. Zip*
24. Legal Plat*
26. I hereby certify that all information contained herein is true and correct.
28. Typed Signature:*
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30. 1. Receive an email copy of this form.
31. Email address

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32. Submit

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