Special Permit Application
Applicant/Agent Information
Name
*
Address
*
City/State/Zip
*
Phone
*
Phone Number with Area Code
Format: (000) 000-0000.
Email
*
example@example.com
Contact Person
*
Owner Information
Name
*
Address
*
City/State/Zip
*
Phone
*
Phone Number with Area Code
Format: (000) 000-0000.
Email
*
example@example.com
Contact Person
*
Proposed Use Information
Present Zoning District
*
Present Land Use
*
Proposed Land Use
*
Reason for Requesting Special Permit
*
Property Information
Legal Description
*
Address of Property
*
Site Size
*
Property Real Estate Number
*
Present Improvements or Structures
*
I, the undersigned am the (choose one) of the aforementioned property situated in the unincorporated portion of Johnson County, Kansas. By execution of my signature, I do hereby Officially apply for a Special Permit as indicated above.
*
Owner
Duly Authorized Agent
Signature
*
If you can’t sign above, please type your name in this box. It will serve as your digital signature.
*
Date
*
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