City of Semmes
Waiver Request Form
Requestor Information
Name:
Date Notified:
Organization
(if applicable):
Phone:
Home:
Cell:
Waiver Information
Proposed Development Name:
Current Use:
Agricultural
Commercial
Industrial Institutional
Residential
Undeveloped
Future
Use:
Agricultural
Commercial
Industrial Institutional
Residential
Undeveloped
Total Acres of Proposed
Development:
Proposed Number of
Lots/Parcels:
Density:
Subdivision
Classification:
Major Subdivision
Minor Subdivision
Waiver Requested from Section:
Basis for Waiver
For Official Use Request Number: