WestColumbiaSpecialExceptionApplicationPage1of4
CITY OF WEST COLUMBIA
Zoning Board of Appeals
SpecialException Appeal
Appeal#: DateFiled: PermitApplication#: 
InstructionsPleaseRead
This form must be completed for a hearing on an applica tion for a special exception.Entries must be printed or
typewritten.If theapplicationison behalfof the property owner(s),all owners must sign.If the applicant is not the
owner,theowner(s)mustsigntheDesignationofAgent.Anaccurate,legibleplotplanshowingpropertydimensions
andlocationsofstructuresandimprovementsmustbeattachedtoanapplicationforaspecialexception.Noapplication
for a special exception will be received for inclusion on the Zoning Board of Appeal’s agenda unless the following
conditionsaremetatleastthirty(30)dayspriortothedateoftheBoardmeeting:
a. Allquestionsonthisapplicationhavebeenfullyanswered(Useadditionalpaperifnecessary);
b. The application has been signed by the owner or agent with the signed Designation of Agent (Signatures
requiredonPage1andonPage2);
c. Aplotplandrawntoscale,showingtheactualdimensionsandshapeofthelot,theexactsizeandlocationson
thelotofallbuildingsandsignsexistingandproposed,andthelocationofallrequiredparkingspaceshasbeen
submitted;
d. TheZoningAdministratorhascertifiedthattheproposeduseandconstructionplanscomplywithallprovisions
oftheZoningOrdinanceexceptthoseforwhichaspecialexceptionhasbeenrequested.
THEAPPLICANTHEREBYAPPEALSFORASPECIALEXCEPTIONASSTATEDWITHINTHIS DOCUMENT
Applicant(s)
Address:
Telephone:(work)  (home)
Owner(s)[ifotherthanApplicant(s)]:
Address:
Telephone:(work)  (home)
(Useadditionalpaperifnecessary)
PropertyAddress:
TaxMap#:
ZoningDistrict:
DESIGNATIONOFAGENT
Completeonlyifownerisnotapplicant
I(we)herebyappointthepersonnamedasApplicantasmy(our)agenttorepresentme(us)inthisapplication.
Ownersignature(s):
Ownerprintednames(s):
Date:
I(we)certifythattheinformationinthisapplicationandtheattacheddocumentationiscorrect.
Applicantsignature(s):
Applicantprintednames(s):
Date:
CreatedApril5,2010
WestColumbiaSpecialExceptionApplicationPage2of4
1. ApplicantherebyappealstotheZoningBoardofAppealsforaspecialexceptionforuseofthepropertydescribedon
page1ofthisapplicationas(natureoftheproposeduse):


which
isapermittedspecialexceptionunderthedistrictregulationinSection
oftheZoningOrdinance.
2. ApplicantwillmeetthestandardsinSection
oftheZoningOrdinancewhichareapplicabletothe
proposedspecialexceptioninthefollowingmanner:




3. ApplicantsuggeststhatthefollowingconditionsbeimposedtomeetthestandardsintheZoningOrdinance:



4. Thefollowingdocumentsaresubmittedinsupportofthisapplication:

(Aplotplanmustbesubmitted.)
PROPOSEDNEWCONSTRUCTION
1. Freestandingstructure,building,orsign Additiontoanexistingstructure,building,orsign
2. Describeuse:
3. Numberofsquarefeet:
Totalnumberofparkingspacesonlot:
4. Maximumheightofstructure,building,orsignabovefinishedgrade:
Numberofstories:
EXISTINGUSESANDBUILDINGONLOT
(Tobeansweredonlyifstructures,buildings,orsignsalreadyexistonlot)
1. Numberofexistingstructures,buildings,orsigns:
2. Sizeanduseofexistingstructures,buildings,orsigns(useadditionalpaperifnecessary):
a. Sq.Ft.
Use:
b. Sq.Ft.
Use:
c. Sq.Ft.
Use:
d. Sq.Ft.
Use:
Applicantsignature(s):
Date:
CreatedApril5,2010
WestColumbiaSpecialExceptionApplicationPage3of4
CreatedApril5,2010
ADMINISTRATIVEUSEONLYAPPLICANTDOESNOTCOMPLETETHISSECTION
TheuseandconstructionasproposedhereincomplieswiththetermsoftheZoningOrdinanceexceptforthe
specialexceptionrequested.
TheuseandconstructionasproposedhereindoesnotcomplywiththetermsoftheZoning Ordinanceexcept
forthespecialexceptionrequested,explainedasfollows:

ZoningAdministratorSignature:
ZONINGBOARDOFAPPEALSUSEONLYAPPLICANTDOESNOTCOMPLETETHISSECTION
1. FindingsoftheZoningBoardofAppeals:
a. EmpoweredtograntaspecialexceptionunderSection
oftheZoningOrdinance:
Yes No
b. Grantingofthisspecialexception:

willadverselyaffectthepublicinterest.

willnotadverselyaffectthepublicinterest
2. Thespecialexceptionisgrantedwiththefollowingcondition,safeguards,orrevisionsasfollowsandasstatedinthe
findingsoffacts:




Timelimitprescribed:

3. Therequestedspecialexceptionisdeniedforthefollowingreasonsandasstatedinthefindings offacts:





RECORDOFVOTE
1.2.
3.
4.
5.



ZoningBoardofAppealsChairmanDate