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Application to Amend the Future Development Map and/or Official Zoning Map of Gordon County, Georgia Application Date: Application Number: (Office Use) Application is hereby made to the Gordon County Planning Commission for the purpose of proposing to amend the Future Development Map and/or Official Zoning Map of Gordon County, Georgia. (Please Print or Type) Applicant: Address: Property Owner: Address: (If different from Above) Phone Number: E-Mail: Agent or Legal Representative: (If applicable) Address: Phone Number: E-Mail: (The applicant and/or representative must be present at all public hearings) Proposal Information Location of Property: (street address, intersecting roads, etc.) Land Lot(s): County Tax Map & Parcel In addition, if proposing an amendment to the Official Zoning Map (rezoning), a copy of a current boundary survey indicating all existing site improvements and floodplain (if any), prepared and sealed by a valid registered architect, engineer, landscape architect or land surveyor, and a legal description of the tract must be submitted with this application. Zoning related to a major subdivision, multi-family or non-residential use or zoning district shall be accompanied by a concept plan prepared by an architect, engineer, landscape architect or land surveyor. U.L.D.C. section (10.02.05) ---PAGE BREAK--- Application Number: Proposal Information (cont.) If proposing a Future Development Map amendment, please provide the following information: Present Map classification: Proposed classification: Present Map classifications of abutting property to the subject property: Reason for the Map amendment: If proposing an Official Zoning Map amendment (rezoning of property), please provide the following information: Present zoning district: Proposed zoning district: Future Development Map classification: Reason for the Zoning Map amendment: Applicant’s Signature Date Property Owner’s Signature (If different) Date Signed and sealed in the presence of: Notary Public Commission Expires ---PAGE BREAK--- Application Number: Please list all individuals, firms and/or corporations owning or leasing property adjacent to the subject property on all sides and across any natural or manmade boundaries (this includes roads, rivers, railroads etc.) and place the owner’s name on the appropriate parcel on the attached survey. PLEASE BE ADVISED THAT RELIANCE ON TAX ASSESSOR’S RECORDS MAY NOT PROVIDE THE APPLICANT WITH THE MOST RECENT OWNERS. NAME ADDRESS 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) ---PAGE BREAK--- DISCLOSURE OF CAMPAIGN CONTRIBUTIONS Regarding Application # Pursuant to O.C.G.A. 36-67A-3, any and all applicants to a rezoning action must make the following disclosures: Please indicate below if you have made a campaign contribution to any member of the Board of Commissioners of Gordon County or any member of the Planning Commission within two years immediately preceding the filing of this application aggregating $250.00 or more or made a gift to any of the above having the aggregate value of $250.00. Board of Commissioners YES NO Bud Owens, Chairman Kevin Cunningham, Vice Chairman Chad Steward Bruce Potts Kurt Sutherland Planning Commission Members Randy Rule, Chairman Jerry Lovelace, Vice-Chairman Sabrina Poole Tommy Hibberts Ken Dinning If yes to any of the above, please indicate again below to whom the donation was made, the dollar amount donated, date of donation, and if a gift, the value and description of said gift: Any applicant failing to make any disclosure as required by O.C.G.A. 36-67A-4 shall be guilty of a misdemeanor. I hereby swear that all the above information is true and correct to the best of my knowledge. Applicant’s Signature Date ---PAGE BREAK--- Cover Sheet Proposal for Land Use Action Application Number: Present Zoning: Proposed Zoning: Date of Planning Commission Meeting: Date of Board of Commissioners’ Meeting: Applicant: Property Owner: (if different from applicant) Property Address: Said Property having a frontage of feet and containing acres. Future Development Map Classification: Current Zoning Map Classification: Proposed Action: Reason for Proposed Action: Directions to Property: