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<br /> <br />Page 2 of 3 <br />GENERAL APPLICATION INFORMATION <br /> <br />1. Name, mailing address and day phone of land owner(s) of record: <br /> Landowner(s) signature(s) required on application form. <br /> <br /> Name: _______________________________________________ <br /> <br /> Mailing Address: _______________________________________________ <br /> <br /> City/State/ZIP: _______________________________________________ <br /> <br /> Day Time Phone: _______________________________________________ <br /> <br /> Email Address: _______________________________________________ <br /> <br />2. Name, mailing address and day phone of authorized agent, if different from landowner of record: <br /> If an authorized agent is indicated, then the authorized agent’s signature is required for application submittal. <br /> <br /> Agent Name: _______________________________________________ <br /> <br /> Mailing Address: _______________________________________________ <br /> <br /> City/State/ZIP: _______________________________________________ <br /> <br /> Day Time Phone: _______________________________________________ <br /> <br /> Email Address: _______________________________________________ <br /> <br />3. Name, mailing address and day phone of other contact person <br />If different than land owner or authorized agent. <br /> <br /> Name: _______________________________________________ <br /> <br /> Mailing Address: _______________________________________________ <br /> <br /> City/State/ZIP: _______________________________________________ <br /> <br /> Day Time Phone: _______________________________________________ <br /> <br /> Email Address: _______________________________________________ <br /> <br />4. Street address of property: <br /> <br /> Address: _______________________________________________ <br /> <br /> City/State/ZIP: _______________________________________________ <br /> <br />5. Legal description of property (attach additional sheets as necessary): <br />_____________________________________________________________________________________________ <br />_____________________________________________________________________________________________ <br /> <br />6. Tax parcel number: _____________________________________________________________ <br /> <br />7. Property size: ____________________________________________________________(acres) <br /> <br />8. Land Use Information: <br /> <br />Zoning: _____________________ Comp Plan Land Use Designation: __________________ <br /> <br />Index #21