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2/2022 Owner Parcel # Mailing Address Permit # City Date Submitted State, Zip 60 Days Day Phone Fee Cell Phone Email Property Address Subdivision Twp Section______ Applicant Applicant Same as Owner Name Address 1 Address 2 City State, Zip Day Phone Email Clay County Planning & Zoning 3510 12th Avenue South, PO Box 280 Moorhead, MN 56561-0280 Tel (218) 299-5005 Application Fee: $225.00 Petition for Rezoning ---PAGE BREAK--- 1. Area of subject property (square feet or acres) : 2. Present Zoning: Proposed 3. Briefly describe the nature and expected effect of the new proposed rezoning: 4. What changes or conditions make passage of this rezoning necessary? 5. Other circumstances which justify this rezoning: 6. Attach sketch plan of site (existing/proposed buildings, wells, septic system, road/property setbacks, etc.) To the best of my knowledge, I certify that the information provided on this application and accompanying documents is true and accurate. Applicant signature: Office Use Only Planning Commission Fee paid: Date paid: Hearing date: Final approval is: ❑ Granted ❑ Denied for the following reasons: Dated this of Chairperson, Clay County Planning Commission Director, Planning & Zoning Board of Commissioners Meeting date: Final approval is: ❑ Granted ❑ Denied for the following reasons: Dated this of Chairperson, Clay County Commission