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ATHENS-CLARKE COUNTY PLANNING DEPARTMENT Athens-Clarke County Planning Department I 120 West Dougherty Street I Athens, GA 30601 I [PHONE REDACTED] accgov.com/planning I Page 1 of 3 I Revised March 2023 For Staff Use: PLAN SUP - - - For Staff Use: PLAN PRE - - - SPECIAL USE PERMIT APPLICATION FEE: Type I - $1,350 Type II - $850 (Cash/card/check – make check payable to ACC) APPLICATION DATE: The application for the Special Use Permit shall be executed by all property owners, including holders of Deeds to Secure Debt, as recorded in the official records of the Superior Court of Athens-Clarke County, or their authorized agents. If more than one person or entity owns the property, attach a list of property owners with name, mailing address, telephone number, and e-mail address for each. Each owner must complete a Declaration of Ownership and, if appropriate, a form to authorize an agent must be signed by each. Also, each owner and authorized agent must file a Campaign Contributions Disclosure. Make copies of these pages as necessary. PROPERTY INFORMATION PROPERTY ADDRESS: COUNTY TAX MAP CURRENT ZONING: CURRENT FLU*: PROPOSED ZONING: PROPOSED FLU (Type I Only): CURRENT USE: PROPOSED USE: ACREAGE: UTILITIES: □ Public Water and Sewer □ Public Water and Septic □ Well and Septic WHEN WAS PROPERTY PURCHASED? Pre-Application Conference A petition for a Special Use Permit will only be accepted after a pre-application conference. Date of Pre-Application Conference: The Unified Government of Athens-Clarke County is a public entity subject to Georgia’s Open Records laws. All submitted applications and associated plans and documents are covered under such laws and may be released to other parties unless they contain information specifically protected by law. I understand that incomplete applications cannot be processed and will result in delay. This application is complete to the best of my knowledge and in accordance with all submittal requirements. APPLICANT’S NAME: APPLICANT’S SIGNATURE: DATE: FOR STAFF USE ONLY: 14 Plan Sets: □ Yes Digital Copy: □ Yes Received by/Date: 14 Application Reports: □ Yes A LEGAL DESCRIPTION BY DEED OR SURVEY MUST BE ATTACHED TO THIS APPLICATION IF METES AND BOUNDS ARE NOT DEPICTED ON SITE PLAN *FLU is an abbreviation for Future Land Use designation ---PAGE BREAK--- Athens-Clarke County Planning Commission – Application for Special Use Permit Athens-Clarke County Planning Department I 120 West Dougherty Street I Athens, GA 30601 I [PHONE REDACTED] accgov.com/planning I Page 2 of 3 I Revised March 2023 Notification to Surrounding Property Owners The applicant shall provide to the Athens-Clarke County Planning Department blank, stamped envelopes of a number sufficient to provide notice to all property owners of parcels lying in whole or in part within a distance of 400 feet of the proposed Special Use Permit as measured from the subject property lines. The owners of record shall be as shown on the Athens-Clarke County Tax Commissioner's records. The Planning Department shall address the stamped envelopes to send letters by regular mail giving notice of the public hearing and of the purpose of the request for a change to the zoning classification. Stamped envelopes are due at the Planning Department at the time of the application deadline. DECLARATION OF OWNERSHIP & AGENT AUTHORIZATION The application shall be executed by all property owners, including holders of Deeds to Secure Debt, as recorded in the official records of the Superior Court of Athens-Clarke County, or their authorized agents. I swear that I am the owner of the property located at which is the subject property of the attached application, as shown in the records of Athens-Clarke County, Georgia Owner’s Name (print): Mailing Address: City, State, Zip Code: Telephone Number: E-Mail Address: OWNERS’S SIGNATURE*: DATE: *If owner is an LLC, corporation, or some other business entity, please provide name of individual signing on behalf of said entity on the provided line below: ORGANIZATION/BUSINESS REPRESENTATIVE*: I authorize the person named below to act as applicant or agent in the pursuit of a Special Use Permit for this property. Agent’s Name (print): Mailing Address: City, State, Zip Code: Telephone Number: E-Mail Address: OWNERS’S SIGNATURE*: DATE: *If owner is an LLC, corporation, or some other business entity, please provide name of individual signing on behalf of said entity on the provided line below: ORGANIZATION/BUSINESS REPRESENTATIVE*: (project address) ---PAGE BREAK--- Athens-Clarke County Planning Commission – Application for Special Use Permit Athens-Clarke County Planning Department I 120 West Dougherty Street I Athens, GA 30601 I [PHONE REDACTED] accgov.com/planning I Page 3 of 3 I Revised March 2023 PROPERTY OWNER'S DISCLOSURE OF CAMPAIGN CONTRIBUTIONS Pursuant to Section 36-67A-1 et seq. of the Georgia Code Annotated, adopted by the Georgia General Assembly, effective July 1, 1986, the following disclosure is mandatory. When any applicant for rezoning action has been made, within two years immediately preceding the filing of that applicant's application for the rezoning action, campaign contributions aggregating $250.00 or more to a local government official, it shall be the duty of the applicant and the agent representing the applicant to file a disclosure report with the governing authority of the respective local government. Any applicant for rezoning action knowingly failing to make any disclosure as required by Code Section 36-67A-1 et seq. shall be guilty of a misdemeanor. A. Name of local government official to whom the campaign contribution or gift was made: B. The dollar amount of each campaign contribution made by the applicant to the local government official during the two years immediately preceding the filing of the application for the Special Use Permit action and the date of each such contribution: Amount: $ Date of Contribution: C. Enumeration and description of each gift having a value of $250.00 or more made by the applicant to the local government official during the two years immediately preceding the filing of this application for Special Use Permit. OWNER’S NAME: OWNERS’S SIGNATURE: DATE: *If owner is an LLC, corporation, or some other business entity, please provide name of individual signing on behalf of said entity on the provided line above. **Agents who are representing property owners must also fill out the attached campaign disclosure form** AGENT'S DISCLOSURE OF CAMPAIGN CONTRIBUTIONS Pursuant to Section 36-67A-1 et seq. of the Georgia Code Annotated, adopted by the Georgia General Assembly, effective July 1, 1986, the following disclosure is mandatory. When any applicant for rezoning action has been made, within two years immediately preceding the filing of that applicant's application for the rezoning action, campaign contributions aggregating $250.00 or more to a local government official, it shall be the duty of the applicant and the agent representing the applicant to file a disclosure report with the governing authority of the respective local government. Any applicant for rezoning action knowingly failing to make any disclosure as required by Code Section 36-67A-1 et seq. shall be guilty of a misdemeanor. A. Name of local government official to whom the campaign contribution or gift was made: B. The dollar amount of each campaign contribution made by the applicant to the local government official during the two years immediately preceding the filing of the application for the Special Use Permit action and the date of each such contribution: Amount: $ Date of Contribution: C. Enumeration and description of each gift having a value of $250.00 or more made by the applicant to the local government official during the two years immediately preceding the filing of this application for Special Use Permit. AGENT’S NAME: AGENT’S SIGNATURE: DATE: *If agent is an LLC, corporation, or some other business entity, please provide name of individual signing on behalf of said entity on the provided line above.