P a g e | 4 Oct 2019
Staff Use Only
A. Land Use Classification(s): __________________________________________________________
B. Zoning Classification(s): ____________________________________________________________
C. Existing Land Use(s): ______________________________________________________________
D. Surrounding Land Use(s): ___________________________________________________________
E. Surrounding Land Use Classification(s): ________________________________________________
F. Surrounding Zoning Classification(s): _________________________________________________
G. Proposed Land Use: _______________________________________________________________
H. Comprehensive Plan: ☐ Consistent ☐ Not Consistent
I. Planning District/Sub Area: _________________________________________________________
J. Census Tract: ____________________________________________________________________
K. Lot and Block:____________________________________________________________________
L. Council District: ☐1 ☐2 ☐3 ☐4 ☐5 ☐6 ☐7 ☐8 ☐9 ☐10 ☐11 ☐12
M. DRC and/or Departments of Development and Transportation and Drainage Compliance:
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
N. Stormwater Management Plan (SMP):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
O. Drainage Impact Study (DIS):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
P. Water Quality Impact Study (WQIS):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
Q. Complete Check List: ☐ No ☐ Yes
R. Comments:______________________________________________________________________
___________________________________________________________________________________
S. Is subject property within Zone of Influence (Zachary, Central, BREC or Health District)? If so,
contact as needed.
☐ No ☐ Yes – date correspondence sent: _________________
T. Is subject property located on MoveBR? If so, contact as needed.
☐ No ☐ Yes – date correspondence sent: _________________
U.
Planning Director or Authorized Signature Date