Application No. ________________
Page 1 of 2
HENDERSON COUNTY
MAP AMENDMENT APPLICATION FORM
GENERAL INFORMATION
Date of Application: ___________________________________
Previously Submitted (Circle One): Yes No
Date of Pre-Application Conference: _____________________
Type of Map Amendment (Circle One): Rezoning Conditional Zoning Special Mixed Use/Conditional
Site Plan Attached (Circle One): Yes No
PARCEL INFORMATION*
PIN: ______________________________ Deed Book/Page: ________ Tract Size (Acres): ___________________
Zoning District: __________ Fire District: _____________ Watershed: ________ Floodplain: __________________
Location of property to be developed: ________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________
*If subject area contains multiple PIN’s please attach a list and the above parcel information for each tract or individual
PIN.
REZONING REQUEST
Attached is:
____ A description of the property in question sufficient to unequivocally describe and identify said property. Such
description may take the form of a property survey, a legal description or a legible copy of a County cadastral or
composite tax map clearly annotated with district lines which follow political boundaries, geographical features
or property lines.
Current Zoning District: _____________________ Requested Zoning District: _____________________________
CONTACT INFORMATION
Property Owner:
Name: ____________________________ Phone: _____________________________________________
Address: __________________________ City, State, and Zip: ___________________________________
Applicant:
Name: ____________________________ Phone: _____________________________________________
Address: __________________________ City, State, and Zip: ___________________________________
Agent:
Name: ____________________________ Phone: _____________________________________________
Address: __________________________ City, State, and Zip: ___________________________________
Agent Form (Circle One): Yes No
Plan Preparer:
Name: ____________________________ Phone: _____________________________________________
Address: __________________________ City, State, and Zip: ___________________________________
