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P a g e | 1 October 2019
Wireless Tower
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: _______________________________________________________________
Email Address: __________________________ Daytime Phone Number: _________________
Business (if applicable): _________________________________________________________
Address: ____________________________ City: ____________ State: ______ ZIP: _________
2. Developer (if applicable): ______________________________________________________
Email Address: ______________________________________________________________
3. Name of Property Owner: _______________________________________________________
Email Address: __________________________ Daytime Phone Number: _________________
Address: _________________________ City: _______________ State: ______ ZIP: _________
4. Subject Property Information:
CPPC Lot ID#(s): _______________________________________________________________
Lot #(s): __________________________________________ Block/Square: _______________
Subdivision or Tract Name: ______________________________________________________
(If property is not subdivided, attach a complete legal description and a survey map indicating
bearings and dimensions.)
Nearest Intersection: ___________________________________________________________
5. Specific Proposed Use (general background): ________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
6. Waiver(s) requested: ☐ No ☐ Yes
If “Yes”, specify the ordinance section, paragraph, and give justification for the requested
waiver(s).
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Date Received: ___________________