Fillable Wireless Tower Staff Use Only City of Baton (City of Baton Rouge / Parish of East Baton Rouge)

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Wireless Tower Staff Use Only City of Baton (City of Baton Rouge / Parish of East Baton Rouge)

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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: ___________________
P a g e | 2 October 2019
7. Provide stamped/sealed plans of the subject property indicating building(s), driveway(s),
parking area(s), street(s), entrance(s), and exit(s) (Per Wireless Tower Site Plan Checklist).
8. 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 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 acknowledge that the Planning Commission makes the final decision on the approval or
denial of this application. I also recognize I do not have a right to an approval, regardless of
staff certification that the application meets ordinance requirements. A Public Hearing is
required to be held and the Planning Commission will make the decision based upon all
evidence presented at the meeting.
I understand that the application fee is nonrefundable. (Applications must be received by
10:00a.m. on the scheduled Application Deadline.)
Application must be signed by both applicant and property owner if different. Letter of
authorization must be submitted in absence of the property owner’s signature or where an
authorized agent signs in lieu of either property owner or applicant.
Signature of Applicant Type or Print Name of Applicant Date
Signature of Property Owner Type or Print Name of Property Owner Date
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signature
click to edit
P a g e | 3 October 2019
Staff Use Only
A. Land Use Classification(s): __________________________________________________________
B. Zoning Classification(s): ____________________________________________________________
C. Existing Land Use(s): ______________________________________________________________
D. Surrounding Land Use(s): ___________________________________________________________
E. Surrounding Land Use Classification(s): ________________________________________________
F. Surrounding Zoning Classification(s): _________________________________________________
G. Proposed Land Use: _______________________________________________________________
H. Comprehensive Plan: ☐ Consistent ☐ Not Consistent
I. Planning District/Sub Area: _________________________________________________________
J. Census Tract: ____________________________________________________________________
K. Lot and Block:____________________________________________________________________
L. Council District: ☐1 ☐2 ☐3 ☐4 ☐5 ☐6 ☐7 ☐8 ☐9 ☐10 ☐11 ☐12
M. Traffic Impact Statement (Conceptual):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
N. Stormwater Management Plan (SMP):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
O. Drainage Impact Study (DIS):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
P. Water Quality Impact Study (WQIS):
☐ No ☐ Yes If “No” explain: ________________________________________________
_______________________________________________________________________________
Q. Complete Check List: ☐ No ☐ Yes
R. Comments: ______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
S. Is subject property within Zone of Influence (Zachary, Central, BREC, or Health District)? If so,
contact as needed.
☐ No ☐ Yes – date correspondence sent: _________________
T. Is subject property located on MoveBR? If so, contact as needed.
☐ No ☐ Yes – date correspondence sent: _________________
U.
Planning Director or Authorized Signature Date
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Wireless Tower Staff Use Only City of Baton (City of Baton Rouge Parish of East Baton Rouge)

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Completed 2 August 2020

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