Fillable Street Name Change Staff Use Only City of (City of Baton Rouge / Parish of East Baton Rouge)

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Street Name Change Staff Use Only City of (City of Baton Rouge / Parish of East Baton Rouge)

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U.S.A. forms for City of Baton Rouge / Parish of East Baton Rouge

BROWSE CITY OF BATON ROUGE / PARISH OF EAST BATON ROUGE (LA) FORMS

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_____ Applicant’s Initials P a g e | 1 October 2019
Date Received: ______________
Street Name Change
City of Baton Rouge / Parish of East Baton Rouge
Office of the Planning Commission, 1100 Laurel Street, Suite 104
Baton Rouge, Louisiana 70802
Staff Use Only
Fee(s): ___________________ Application Taken by: ___________
Case Number: _________________ Meeting Date: _________________
MPN Project Number: _______________
Please Print or Type (all entities listed below will be copied on all comments)
1. Applicant Name and Title: _____________________________________________________
Email Address: __________________________ Daytime Telephone: ___________________
Address: ________________________ City: ___________ State: _________ ZIP: _________
Business (if applicable): _______________________________________________________
2. Developer (if applicable): ______________________________________________________
Email Address: ______________________________________________________________
3. Name of existing street(s): _____________________________________________________
4. Name of proposed street(s):____________________________________________________
Subdivision (if applicable): _____________________________________________________
Location: ___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
5. Specific reason for the requested change: ________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. Number of property owners directly affected by this request: _________________________
7. Petition for Street Name Change:
Complete the attached petition for Street Name Change, failure to provide all information
on the petition may delay the processing of your application.
8. Number of lots abutting the subject street(s): _____________________________________
9. Acknowledgement:
I acknowledge that private deed restrictions or covenants may exist on the subject property. I
recognize that neither the Planning Commission nor its staff may consider such deed
restrictions or covenants, if any, when determining approval or denial of an application, nor can
_____ Applicant’s Initials P a g e | 2 October 2019
the City or Parish enforce private deed restrictions or covenants. It is my responsibility as an
Applicant to determine if any such deed restrictions and covenants exist on the subject
property, and to be aware that violations of the same subject me and/or Property Owner to
litigation from others.
I understand that the application and advertising fees are to be made at the time the
application is submitted and are nonrefundable. (Applications must be received by 10:00
a.m. on the scheduled Application Deadline).
Signature of Applicant Type or Print Name of Applicant Date
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P a g e | 3 October 2019
Petition for Street Name Change
Name of Abutting
Property Owner
Signature of Abutting
Property Owner
Lot/Tract
Description
Address of Property
P a g e | 4 October 2019
Staff Use Only
A. Lot and Block Sheet Map: _____________________________________________________
B. Planning District/Sub Area: ____________________________________________________
C. Council District: ☐1 ☐2 ☐3 ☐4 ☐5 ☐6 ☐7 ☐8 ☐9 ☐10 ☐11 ☐12
D. Petition of Majority (50% + 1): __________________________________________________
E. List of all abutting property owners: _____________________________________________
___________________________________________________________________________
F. Fee of $200: _______________________________
G. Agencies to be notified by the Planning Commission office:
1. Department of Public Works ________________________
2. Emergency Medical Services ________________________
3. Fire Department ________________________
4. Fire Protection District ________________________
5. City Police Department ________________________
6. E.B.R.P. Sheriff’s Office ________________________
7. Utility Companies ________________________
a. Entergy ________________________
b. South Central Bell ________________________
c. TCI of Louisiana ________________________
d. B.R. Water Company ________________________
e. Parish Water Company ________________________
f. Red Oaks Water Company ________________________
g. Dixie Electric Membership Company ________________________
H. Comments: ________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
I.
Planning Director or Authorized Signature Date
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Street Name Change Staff Use Only City of (City of Baton Rouge Parish of East Baton Rouge)

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Completed 2 August 2020

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