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Application for Conditional Use Gordon County, Georgia Application Date: Application Number: (Office Use) Application is hereby made to the Gordon County Planning Commission for the purpose of seeking approval of a Conditional Use in accordance with Article VII; Section 7.15.2 of the Official Zoning Ordinance of Gordon County, Georgia. The Planning Commission will hear this application on with Final Action by the Board of Commissioners on (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): District(s): Section(s): Acreage: County Tax Map& Parcel ---PAGE BREAK--- Application Number: 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, must be submitted with this application. Present zoning district: Proposed Conditional Use: 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.). For Dry Litter Poultry Operations, also include all properties within one thousand (1,000) feet of the property for which the change in zoning is sought. 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) Please attach additional pages if necessary) ---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 Ken Dinning Tommy Hibberts 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 Proposed 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. Official Zoning Map Classification: Proposed Conditional Use: Directions to Property: ---PAGE BREAK--- Application Submittal Requirements for Dry Litter Poultry Operation A) Development and Design Plan. A comprehensive, detailed site plan showing and identifying significant onsite and proposed features, to include: The boundaries of the parcel of land by survey. Any existing and proposed structures on the property. Any water impoundments and/or waterways on the property. Any existing and proposed septic systems. Any existing and proposed screening. Any public roadways directly serving the parcel of land. Required setbacks. See ULDC S 4.03.02 Required buffer zones as described in ULDC S 4.03.02(J) Any existing and proposed utility lines. (10) Existing and proposed topographic contours at vertical intervals of five feet maximum. (U.S.G.S. topographic maps may be used for existing contours). (11) The design of the chicken houses, stack houses and operations should minimize the impacts of the poultry house on adjacent properties. For example, the ventilation fan exhausts should be directed away from the closest property lines of adjoining properties. B) Nutrient (Waste) Management Plan. The Design and Development Plan shall include a Nutrient (Waste) Management Plan (NMP) that establishes the methods by which waste generated as part of the Dry Litter Poultry Operation will be managed and disposed of including any temporary storage of such waste if managed on-site The NMP shall, at a minimum, include best management practices and procedures necessary to implement applicable effluent limitations and standards. A copy of the plan must be maintained on site and available for inspection by the Ordinance Officer upon his request.