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Application for Variance from the Official Zoning Ordinance of Gordon County, Georgia Application Date: Application Number: (Office Use) Application is hereby made to the Gordon County Planning Commission for the purpose of seeking a variance from the terms of the Official Zoning Ordinance of Gordon County, Georgia. The Planning Commission will hear this application 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) Request Information Location of Property: (street address, intersecting roads, etc.) Land Lot(s): District(s): Section(s): Acreage: County Tax Map and Parcel ---PAGE BREAK--- Application Number: Request Information (cont.) Present Zoning District: Variance Request: (Please include Zoning Ordinance Article and Section number) In accordance with Unified Land Development Code Section 9.02.01(6), in determining whether to grant a variance, the Gordon County Planning Commission shall consider, along with other relevant facts, the following: a. There are extraordinary and exceptional conditions pertaining to the particular piece of property in question because of its size, shape or topography. b. The application of this ULDC to this particular piece of property would create an unnecessary hardship. c. Such conditions are peculiar to the particular piece of property involved. d. Relief, if granted, would not cause substantial detriment to the public good or impair the purposes and intent of this ULDC, provided, however, that no variance may be granted for a use of land or building or structure that is prohibited by this ULDC. Upon review of the above criteria, please state the reason (HARDSHIP) for the requested variance: 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 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) 17) (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 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 Request for Variance Application Number: Date of Planning Commission Meeting: Applicant: Property Owner: (if different from applicant) Property Address: Said Property having a frontage of feet and containing acres. Official Zoning Map Classification: Requested Variance: Zoning Ordinance Section: Reason for Variance: Directions to Property: