SUMNER C
OUNTY REGIONAL PLANNING C
OMMISSION
355 N. Belvedere Drive, Room 202, Gallatin, Tennessee 37066
OFFICE (615)451-6097 FAX (615) 451-6074
SUBDIVISION VARIANCE/WAIVER APPLICATION
Applicant/ Developer
Mailing Address City State Zip
Phone Number Fax Number Email
Project Engineer/Surveyor
Mailing Address City State Zip
Phone Number Fax Number Email
The applicant is responsible for notifying the Planning Department if any contact information has changed.
PLEASE COMPLETE THE FOLLOWING INFORMATION:
Name of Subdivision Section Number (if applicable) Date of application
Tax Map Group Parcel Deed Book Page Number
Type(s) of Variance Requested
Briefly Explain Reason Variance is Needed (Attach Additional Documentation if Necessary)
I hereby certify that the information contained in this application is true and correct to the best of my
knowledge and belief.
Applicant’s Signature
Applicant’s Name (
Printed)
Date
STAFF USE ONLY
Accepted By
Date
Variance #
P.C._
_______
