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	text-autospace:none;
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	margin:0in;
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</head>

<body lang=3DEN-US style=3D'tab-interval:.5in;text-justify-trim:punctuation=
'>

<div class=3DSection1>

<p class=3DTxBrt1 style=3D'line-height:normal'><o:p>&nbsp;</o:p></p>

<table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D768
 style=3D'width:8.0in;margin-left:-4.5pt;border-collapse:collapse;mso-yfti-=
tbllook:
 1184;mso-padding-alt:0in 0in 0in 0in'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes;
  height:123.0pt'>
  <td width=3D768 valign=3Dtop style=3D'width:8.0in;border:solid windowtext=
 1.0pt;
  border-left:none;mso-border-top-alt:solid windowtext .75pt;mso-border-bot=
tom-alt:
  solid windowtext .75pt;mso-border-right-alt:solid windowtext .75pt;
  padding:0in 0in 0in 0in;height:123.0pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;
  </span><br style=3D'mso-special-character:line-break'>
  <![if !supportLineBreakNewLine]><br style=3D'mso-special-character:line-b=
reak'>
  <![endif]></p>
  <p class=3DMsoBodyText>Date submitted: ______________<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;
  </span>Date notice sent_____________<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;
  </span><b><span style=3D'color:red'>File<span style=3D'mso-spacerun:yes'>=
&nbsp;
  </span>no.:_______________</span></b><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  </span>Date of public hearing______________<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;
  </span><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;</span><b><span
  style=3D'color:red'>Filing fee: <u>$ 75.00</u></span></b><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  </span>Abutting property owners&#8217; list received___________________<s=
pan
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;
  </span>Date advertised______________<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;
  </span>PC recommendation<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;
  </span>__Approved<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;
  </span>__Disapproved<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  </span>Date________<br>
  Date advertised______________<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;
  </span>Governing body action<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;
  </span>__Approved<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;
  </span>__Disapproved<span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  </span>Date___________<br>
  <span style=3D'mso-spacerun:yes'>&nbsp;</span><br style=3D'mso-special-ch=
aracter:
  line-break'>
  <![if !supportLineBreakNewLine]><br style=3D'mso-special-character:line-b=
reak'>
  <![endif]></p>
  <p class=3DMsoNormal><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  </span><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span><b>Above
  for office use only</b>.</p>
  </td>
 </tr>
</table>

</div>

<b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;mso=
-bidi-font-size:
12.0pt;font-family:"Times New Roman","serif";mso-fareast-font-family:"Times=
 New Roman";
mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'=
><br
clear=3Dall style=3D'page-break-before:auto;mso-break-type:section-break'>
</span></b>

<div class=3DSection2>

<p class=3DTxBrc7 style=3D'line-height:normal;tab-stops:4.85pt'><b><span
style=3D'font-size:12.0pt'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></b><b><span style=3D'font-size:13.0pt;mso-bidi-font-size:12.=
0pt'>Date:
____________ ___, </span></b><b><span style=3D'font-size:12.0pt'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;</span><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span><o:p></o:p></span></b></p>

<p class=3DTxBrc7 style=3D'line-height:normal;tab-stops:4.85pt'><b><span
style=3D'font-size:12.0pt'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;
</span><o:p></o:p></span></b></p>

<p class=3DTxBrc7 style=3D'line-height:normal;tab-stops:4.85pt'><b><span
style=3D'font-size:12.0pt'><span style=3D'mso-spacerun:yes'>&nbsp;
</span>APPLICATION FOR A CHANGE OF ZONING IN<span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span><st1:PlaceName w:st=3D"on">Johnson</st1:PlaceName> <st1:PlaceType w:=
st=3D"on">County</st1:PlaceType>
<st1:place w:st=3D"on"><st1:State w:st=3D"on">Nebraska</st1:State></st1:pla=
ce></span></b><b><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><span style=3D'mso-tab-=
count:
1'>&nbsp;&nbsp; </span><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;
</span><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</s=
pan></span></b><b><span
style=3D'font-size:12.0pt;font-family:"Arial","sans-serif"'><o:p></o:p></sp=
an></b></p>

<p class=3DMsoNormal style=3D'tab-stops:166.95pt 304.15pt'><span style=3D'f=
ont-size:
5.0pt;mso-bidi-font-size:12.0pt;font-family:"Arial","sans-serif"'><o:p>&nbs=
p;</o:p></span></p>

<p class=3DMsoNormal style=3D'tab-stops:10.2pt'><b style=3D'mso-bidi-font-w=
eight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbs=
p;</o:p></span></b></p>

<p class=3DTxBrp9 style=3D'margin-left:20.25pt;text-indent:-.25in;line-heig=
ht:15.0pt;
mso-line-height-rule:exactly;mso-list:l2 level1 lfo2;tab-stops:10.2pt list =
20.25pt'><![if !supportLists]><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>1.<sp=
an
style=3D'font:7.0pt "Times New Roman"'> </span></span></b><![endif]><b
style=3D'mso-bidi-font-weight:normal'>Items on these sheets must be filled =
out
completely before acceptance of this application for processing. <u>Please
print or type</u>. <o:p></o:p></b></p>

<p class=3DTxBrp9 style=3D'margin-left:20.25pt;text-indent:-.25in;line-heig=
ht:15.0pt;
mso-line-height-rule:exactly;mso-list:l2 level1 lfo2;tab-stops:10.2pt list =
20.25pt'><![if !supportLists]><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>2.<sp=
an
style=3D'font:7.0pt "Times New Roman"'> </span></span></b><![endif]><b
style=3D'mso-bidi-font-weight:normal'>If more space is needed use additional
sheets.<o:p></o:p></b></p>

<p class=3DTxBrp9 style=3D'margin-left:20.25pt;text-indent:-.25in;line-heig=
ht:15.0pt;
mso-line-height-rule:exactly;mso-list:l2 level1 lfo2;tab-stops:10.2pt list =
20.25pt'><![if !supportLists]><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>3.<sp=
an
style=3D'font:7.0pt "Times New Roman"'> </span></span></b><![endif]><b
style=3D'mso-bidi-font-weight:normal'>Contact the Johnson County Zoning
Administrator at <u>402-335-7068</u> if you have any questions.<o:p></o:p><=
/b></p>

<p class=3DTxBrp9 style=3D'margin-left:20.25pt;text-indent:-.25in;line-heig=
ht:15.0pt;
mso-line-height-rule:exactly;mso-list:l2 level1 lfo2;tab-stops:10.2pt list =
20.25pt'><![if !supportLists]><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>4.<sp=
an
style=3D'font:7.0pt "Times New Roman"'> </span></span></b><![endif]><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'color:red'>Filing fee:=
 <u>$
75.00</u>.</span><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </spa=
n><u>Make
checks payable to <st1:place w:st=3D"on"><st1:PlaceName w:st=3D"on">Johnson=
</st1:PlaceName>
 <st1:PlaceType w:st=3D"on">County</st1:PlaceType></st1:place>.</u><o:p></o=
:p></b></p>

<p class=3DTxBrp9 style=3D'margin-left:20.25pt;text-indent:-.25in;line-heig=
ht:15.0pt;
mso-line-height-rule:exactly;mso-list:l2 level1 lfo2;tab-stops:10.2pt list =
20.25pt'><![if !supportLists]><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>5.<sp=
an
style=3D'font:7.0pt "Times New Roman"'> </span></span></b><![endif]><b
style=3D'mso-bidi-font-weight:normal'>Property owners within 1 mile
(unincorporated) and 100 feet (incorporated) areas will receive written not=
ice
of this request.<u> </u><o:p></o:p></b></p>

<p class=3DMsoNormal style=3D'line-height:15.0pt;mso-line-height-rule:exact=
ly;
tab-stops:10.2pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>1</b><b style=3D'mso-bidi=
-font-weight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'>.<span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span>Appl=
icant&#8217;s
name</b><b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8=
.0pt;
mso-bidi-font-size:12.0pt'>:
___________________________________________________________________________=
______________________________<o:p></o:p></span></b></p>

<p class=3DMsoNormal style=3D'line-height:11.9pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>2</b><b style=3D'mso-bidi=
-font-weight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'>.<span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span>Appl=
icant&#8217;s
home address</b><b style=3D'mso-bidi-font-weight:normal'><span style=3D'fon=
t-size:
8.0pt;mso-bidi-font-size:12.0pt'>:
_____________________________________________________________________</span=
>ZIP
code: _____________</b><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p></o:p></span></b><=
/p>

<p class=3DMsoNormal style=3D'line-height:11.9pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>3.</b><b style=3D'mso-bid=
i-font-weight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span>Tele=
phone
(home): ______________________ (Work): __________________________</b><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;mso-bi=
di-font-size:
12.0pt'><o:p></o:p></span></b></p>

<p class=3DMsoNormal style=3D'line-height:11.9pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>4.<span style=3D'mso-tab-=
count:
1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Present use of subject property<sp=
an
class=3DGramE>:_</span>____________________________________________________=
____________________<o:p></o:p></b></p>

<p class=3DMsoNormal style=3D'line-height:11.9pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><o:p>&nbsp;</o:p=
></b></p>

<p class=3DTxBrp11 style=3D'margin-left:21.8pt;text-indent:-21.75pt;line-he=
ight:
normal;mso-list:l1 level1 lfo4;tab-stops:list 21.8pt'><![if !supportLists]>=
<b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>5.<sp=
an
style=3D'font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;
</span></span></b><![endif]><b style=3D'mso-bidi-font-weight:normal'>Desire=
d use
of subject property:_______________________________________________________=
___________________<o:p></o:p></b></p>

<p class=3DTxBrp11 style=3D'margin-left:.05pt;text-indent:0in;line-height:n=
ormal;
tab-stops:21.8pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrt18 style=3D'line-height:normal;tab-stops:21.5pt 219.65pt'><b
style=3D'mso-bidi-font-weight:normal'>6.<span style=3D'mso-tab-count:1'>&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Present
zoning: _______________________________<span style=3D'mso-tab-count:1'>&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp; </span>Requested
zoning<span class=3DGramE>:_</span>______________________________________<o=
:p></o:p></b></p>

<p class=3DMsoNormal style=3D'tab-stops:21.5pt 219.65pt'><b style=3D'mso-bi=
di-font-weight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbs=
p;</o:p></span></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>7.<span style=3D'mso-tab-=
count:
1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Legal description of property to be
rezoned: _______________________________________________________________<o:=
p></o:p></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>____________________________________________________________________=
_________________________________<o:p></o:p></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>____________________________________________________________________=
_________________________________<o:p></o:p></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>____________________________________________________________________=
_________________________________<o:p></o:p></b></p>

<p class=3DMsoNormal style=3D'line-height:11.9pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp11 style=3D'margin-left:21.8pt;text-indent:-21.75pt;line-he=
ight:
normal;mso-list:l0 level1 lfo6;tab-stops:list 21.8pt'><![if !supportLists]>=
<b
style=3D'mso-bidi-font-weight:normal'><span style=3D'mso-list:Ignore'>8.<sp=
an
style=3D'font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;
</span></span></b><![endif]><b style=3D'mso-bidi-font-weight:normal'>Area of
subject property (square feet or acres):
____________________________________________________________<o:p></o:p></b>=
</p>

<p class=3DMsoNormal style=3D'tab-stops:21.8pt'><b style=3D'mso-bidi-font-w=
eight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbs=
p;</o:p></span></b></p>

<p class=3DTxBrp10 style=3D'text-indent:-14.1pt;line-height:15.0pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>9.<span style=3D'mso-tab-=
count:
1'>&nbsp;&nbsp; </span>Indicate uses of the adjoining properties (note the =
zoning
district designation and the actual use of the properties):<o:p></o:p></b><=
/p>

<p class=3DMsoNormal style=3D'line-height:15.0pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp13 style=3D'margin-left:23.0pt;line-height:normal;tab-stops=
:22.95pt'><b
style=3D'mso-bidi-font-weight:normal'>North:
_________________________________________ South:
_____________________________________________<o:p></o:p></b></p>

<p class=3DMsoNormal style=3D'tab-stops:22.95pt'><b style=3D'mso-bidi-font-=
weight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbs=
p;</o:p></span></b></p>

<p class=3DMsoNormal style=3D'tab-stops:22.95pt'><b style=3D'mso-bidi-font-=
weight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbs=
p;</o:p></span></b></p>

<p class=3DTxBrp14 style=3D'margin-left:22.15pt;line-height:normal'><b
style=3D'mso-bidi-font-weight:normal'>East:
___________________________________________West: __________________________=
____________________<o:p></o:p></b></p>

<p class=3DMsoNormal style=3D'tab-stops:22.1pt'><b style=3D'mso-bidi-font-w=
eight:
normal'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbs=
p;</o:p></span></b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>10.<span style=3D'mso-tab=
-count:
1'>&nbsp;&nbsp;&nbsp; </span>If exhibits are furnished, please describe and
enumerate. Page 4 has been furnished for a plot or site plan drawing for
showing existing and proposed structures, easements, roads etc.<o:p></o:p><=
/b></p>

<p class=3DTxBrp15 style=3D'margin-left:22.15pt;line-height:11.9pt;mso-line=
-height-rule:
exactly'><b style=3D'mso-bidi-font-weight:normal'>11.<span style=3D'mso-tab=
-count:
1'>&nbsp;&nbsp;&nbsp; </span><span class=3DGramE>The</span> zoning administ=
rator,
who may be accompanied by others, is hereby authorized to enter upon the
property during normal working hours for the purpose of becoming familiar w=
ith
the proposed situation.<o:p></o:p></b></p>

<p class=3DMsoNormal style=3D'line-height:11.9pt;mso-line-height-rule:exact=
ly;
tab-stops:22.1pt'><b style=3D'mso-bidi-font-weight:normal'><span
style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p></span=
></b></p>

<p class=3DTxBrp16 style=3D'margin-left:68.9pt;line-height:11.9pt;mso-line-=
height-rule:
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authorized agent: _______________________ Date: ___________________</span><=
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