Fillable SUMNER COUNTY BOARD OF ZONING APPEALS

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SUMNER COUNTY BOARD OF ZONING APPEALS

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SUMNER COUNTY BOARD OF ZONING APPEALS
355 N. Belvedere Drive Room 202, Gallatin, Tennessee, 37066
OFFICE: (615) 451-6097 FAX: (615) 451-6074
SPECIAL EXCEPTION APPLICATION
Date Submitted:
Tax Map:
Group:
Parcel:
Acres:
Zoning:
Project Address:
Property Owner:
Address:
City:
Zip Code:
Phone:
Email:
Applicant: (If different from property owner)
Address:
City:
Zip Code:
Phone:
Email:
Was a pre-application meeting held with staff? Yes No
Date of Meeting:
Purpose: Briefly describe the reason for this application
Signature of Owner or Owner’s Agent:
I hereby certify this information to be correct and true to the best of my knowledge:
Signature of property owner: ________________________________________
Date:_____________________________
Page 2 of 2
Items required at time of application submittal:
1. _____ Application
2. _____ Application Fee of $300.00 (a $300.00 fee will be due every two (2) years upon request for this
Conditional Use Permit be continued by the Board of Zoning Appeals)
3. _____ Warranty Deed
4. _____ Copy of the septic permit OR an affidavit of disclosure from the Environmental Dept. (Room 208)
5. _____ Obtain Public Notice Sign ($25 per road frontage, posted through meeting date & returned to Room 202)
6. _____ Plot Plan containing all information listed below:
• Show how many feet that any existing and/or proposed building(s) are located from all property line
boundaries, fences, and other structures located on the property.
• Show setbacks and easements (if applicable) to the property.
• Show the septic system.
• Show the drain field (s)
• Show the locations of signs (if any). A sign application is required with this request
• Show location of vehicle parking spaces AND indicate if your intentions are to request a variance for a
“Dust Free Parking Surface”
• Show how many vehicle parking spaces including any handicap parking
• Specify if the vehicle spaces are to be used for customer parking or semi-temporary parking
• Show existing or proposed landscape buffers, screening, fencing, entrance(s) from the county approved road(s)
Received by:___________________ Date: ______________________ Receipt #:_____________________
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SUMNER COUNTY BOARD OF ZONING APPEALS

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Completed 13 December 2020

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