Case No.________________________________ Date filed: _______________

Fee: $400.00 Receipt No. ______________

Type of district desired______________________________________________

Applicant: _______________________________________________________

Mailing Address:__________________________________________________

Phone: ________________

Agent: __________________________________________________________

Mailing Address:____________________________________________________

Phone: ________________

Location of property requested for Historic Overlay Zone: ______________________________________________________________________

(general part of town)
Legal description of metes & bounds if unplatted: ______________________________________________________________________
Present use of property: ______________________________________________________________________
Present Zoning of property:_______________________________________________________________

Date of Landmarks Commission consideration: ____________________________________
Earliest possible date of Planning & Zoning Commission consideration: _________________
Earliest possible date of City Council hearing (second reading): ________________________

Notes: ______________________________________________________________________

The undersigned has read the application and does hereby certify that all information contained therein is a true statement; and does hereby request that all necessary legal steps be taken to submit such request to the Commission at its next regular meeting. I further certify that I have been informed of the times(s) and date(s) that this request will be heard by the Landmarks Commission, Planning and Zoning Commission and City Council (if applicable). In addition, the staff will make a recommendation for approval or disapproval to both Commission and City Council on all requests. This recommendation will be made known to the proponent upon request approximately one week before the scheduled meeting of the Landmarks Commission.

Signed: _____________________________________________________

Application received by: ________________________________________
Describe the boundaries of the district: attach map
______________________________________________________________________________

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