Fillable Form 20589 Personal Wireless Service Facilities Colocation* (City of Gahanna)

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Form 20589 Personal Wireless Service Facilities Colocation* (City of Gahanna)

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The Form 20589 Personal Wireless Service Facilities Colocation* (City of Gahanna) form is 3 pages long and contains:

  • 4 signatures
  • 24 check-boxes
  • 52 other fields

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File type: PDF

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RECEIVED: ________
DATE: ____________
PAID: _____________
DATE: ______________
CHECK#: ____________
Zoning File No. _________________
PC Meeting Date: _______________
PC File No. ____________________
INTERNAL USE
ZONING DIVISION
200 S. Hamilton Road
Gahanna, Ohio 43230
614-342-4025
zoning@gahanna.gov
www.gahanna.gov
COLOCATION - PERSONAL WIRELESS SERVICE FACILITIES APPLICATION
PLEASE NOTE: This application is not to be considered complete until all documents are received and approved by the Planning & Zoning Administrator.
Project/Property Address or Location: Project Name/Business Name (if applicable):
Parcel ID No.(s):
Current Zoning:
Total Acreage:
Describe location and siting information:
Select Type of Entity & Provide: name, state where formed & date formed
Limited Liability Company:
Partnership:
Other:
APPLICANT Name (primary contact) -do not use a business name:
Applicant Address:
Applicant E-mail:
Applicant Phone No.:
BUSINESS Name (if applicable):
ATTORNEY/AGENT Name:
Attorney/Agent Address:
Attorney/Agent E-Mail:
Attorney/Agent Phone No.:
ADDITIONAL CONTACTS (please list all applicable contacts)
Name(s):
Contact Information (phone no./email):
Contractor
Developer
Architect
PROPERTY OWNER Name: (if different from Applicant)
Property Owner Contact Information (phone no./email):
APPLICANT SIGNATURE BELOW CONFIRMS THE SUBMISSION REQUIREMENTS HAVE BEEN COMPLETED (see page 2)
I certify that the information on this application is complete and accurate to the best of my knowledge, and that
the project as described, if approved, will be completed in accordance with the conditions and terms of that
approval.
Applicant Signature: _____________________________________________ Date: ____________________
THIS FORM IS AVAILABLE TO BE SUBMITTED ONLINE: www.gahanna.gov
Page 1 of 3|CO-LOCATION PWSF|REV.4.14.17
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ZONING DIVISION
200 S. Hamilton Road
Gahanna, Ohio 43230
614-342-4025
zoning@gahanna.gov
www.gahanna.gov
CO-LOCATION - PERSONAL WIRELESS SERVICE FACILITIES APPLICATION – SUBMISSION REQUIREMENTS
PLEASE NOTE: This application is not to be considered complete until all documents are received and approved by the Planning & Zoning Administrator.
APPLICATION ACCEPTANCE
This application has been reviewed and is considered complete and is hereby accepted by the Zoning Division of
the City of Gahanna and shall be:
Forwarded with an application request for a Conditional Use to the City of Gahanna Planning Commission
for consideration.
Considered for review by the Planning & Zoning Administrator.
Planning & Zoning Administrator Signature: _______________________________________ Date: ___________
APPROVAL BY THE PLANNING & ZONING ADMINISTRATOR
In accordance with Section 1181 of the Codified Ordinances of the City of Gahanna, Ohio, I hereby certify that this
project, as stated above, was approved by the Planning & Zoning Administrator on __________________________. The
applicant shall comply with any conditions approved by the Planning & Zoning Administrator and shall comply with all
building, zoning and landscaping regulations of the City of Gahanna.
Planning & Zoning Administrator Signature: _______________________________________ Date: __________
Chief Building Official Signature: _______________________________________________ Date: __________
Director of Public Service Signature: ____________________________________________ Date: __________
City Engineer Signature: ______________________________________________________ Date: __________
This application will be forwarded to Planning Commission read by title at the first regular meeting of Planning Commission following
approval by the Planning & Zoning Administrator.
STAFF
USE -
INTAKE
TO BE COMPLETED/SUBMITTED BY THE APPLICANT:
APPLICANT
STAFF USE
YES
N/A
YES
N/A
1. Review Gahanna Code Section 1181(visit www.municode.com)
2. Verification that this co-location was previously approved
3. Pre-application conference with staff
4. Survey of property certified by a registered surveyor (11”x17” copy)
5. Legal description of property certified by a registered surveyor
(11”x17” copy)
6. List of 3 emergency 24/7 system representatives (include: contact name,
number(s), email address)
7. Application fee (in accordance with the Building & Zoning Fee Schedule)
8. Application & all supporting documents submitted in digital format
9. Application & all supporting documents submitted in hardcopy format
10. Authorization Consent Form Complete & Notarized (see page 3)
INTERNAL USE
INTERNAL USE
THIS FORM IS AVAILABLE TO BE SUBMITTED ONLINE: www.gahanna.gov
Page 2 of 3|CO-LOCATION PWSF|REV.4.14.17
ZONING DIVISION
200 S. Hamilton Road
Gahanna, Ohio 43230
614-342-4025
zoning@gahanna.gov
www.gahanna.gov
AUTHORIZATION CONSENT FORM
(must sign in the presence of a notary)
If you are filling out more than one application for the same project & address, you may submit a copy of this form with additional applications.
AUTHORIZATION FOR OWNER’S APPLICANT OR REPRESENTATIVE(S) If the applicant is not the property owner, this section
must be completed & notarized.
I, _______________________________________, the owner or authorized owner’s representative of the subject property listed on
this application, hereby authorize _________________________________________ to act as my applicant or representative(s) in all
matters pertaining to the processing and approval of this application, including modifying the project. I agree to be bound by all terms
and agreements made by the designated representative.
Property Owner Signature: _______________________________________________ Date: ____________________
AUTHORIZATION TO VISIT THE PROPERTY
I, ___________________________________, the owner or authorized owner’s representative of the subject property listed on this
application, hereby authorize City representatives to visit, photograph and post notice (if applicable) on the property as described in
this application.
Property Owner Signature: _______________________________________________ Date: ____________________
Subscribed and sworn to before me on this ______ day of ________________, 20______.
State of _________________ County of __________________
Stamp or Seal
Notary Public Signature: _______________________________________________
AGREEMENT TO COMPLY AS APPROVED
I, ___________________________________, the applicant of the subject property listed on this application, hereby agree that the
project will be completed as approved and any proposed changes to the approved plans shall be submitted for review and approval
to the Zoning Division staff.
Applicant Signature: ____________________________________________________ Date: ____________________
Subscribed and sworn to before me on this ______ day of ________________, 20______.
State of _________________ County of __________________
Stamp or Seal
Notary Public Signature: _______________________________________________
NOTARY
NOTARY
Page 3 of 3|CO-LOCATION PWSF|REV.4.14.17
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Form 20589 Personal Wireless Service Facilities Colocation* (City of Gahanna)

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Completed 14 July 2020

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