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R:drive: Planning and Development/Forms Zoning and Variance Application Revised 2011 MINOR WAIVER APPLICATION COLUMBIA COUNTY, GEORGIA Date of Application: Current Zoning District: Minor Waiver : The undersigned requests a minor waiver in accordance with Section 90-179 of the Columbia County Code of Ordinances. Disapproval: The undersigned understands that if this request is disapproved, a variance application may be necessary as per Section 90-179 of the Columbia County Code of Ordinances. PROPERTY INFORMATION: Tax Map # Parcel # Address: Property area is approximately acres / square feet (delete one). The attached plat for the property was prepared SETBACK INFORMATION: Setback required by code/ Setback Request: (maximum 10% Note: No side or rear setback can be less than five feet on any residential lot for detached homes. Please confirm that the following criteria are met: All minimum building codes are met. No utility services or easements will be affected. Reason for request: OWNERSHIP AND APPLICANT INFORMATION: OWNER: APPLICANT: ADDRESS: ADDRESS: CITY: STATE: ZIP: CITY: STATE: PHONE PHONE#: Email (or) Fax: Email (or) Fax: I hereby depose and say under the penalty of perjury that all of the statements contained in or submitted with this application are true. Owner’s Signature Applicant’s Signature Printed Name Printed Name Subscribed and sworn to before me on day of 20 . By: Notary Public Please return original, notarized application with all supporting documentation and your $100.00 application fee to: Columbia County Planning and Engineering Department, P.O. Box 498, Evans, GA 30809 Date Received: PC Report Date: File # Date Disapproved: Date Approved: