SUMNER COUNTY REGIONAL PLANNING COMMISSION
355 North Belvedere Drive, Room 202
Gallatin, Tennessee 37066
OFFICE (615) 451-6097 FAX (615) 451-6074
ADMINISTRATIVE APPEALS APPLICATION
$75 Fee
Applicant’s Name Date of application
Applicant’s 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 PROPERTY INFORMATION:
Property Owner (If different from Applicant)
Property Address City State
Tennessee
Zip
Tax Map Group Parcel Deed Book Page
PLEASE COMPLETE THE FOLLOWING APPEALS INFORMATION:
Name of the Department whose order, requirement, decision, or determination is being appealed, and
the nature of the appeal:
Date in which order, requirement, decision or determination was given:
Please describe in detail why you feel the order, requirement, decision, or determination was inconsistent
with the Sumner County Zoning Resolution, and the nature of said inconsistency:
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
Appli
cant’s Name (Printed)
Date
STAFF USE ONLY
Accepted By Application Number
Receipt
number
