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Planning & Development 1266 East Church Street Hall C Jasper, GA 30143 [PHONE REDACTED] [EMAIL REDACTED] Conditional Use Application Applications submitted without all required attachments will be REJECTED. The applicant, or a representative, capable of answering questions about the project must attend the public hearings for the request to be considered. Failure to appear at a meeting constitutes abandonment and dismissal of the case, unless the applicant shows just cause by reason of illness or health or other emergency within a reasonable time, in writing, and accompanied by new costs for re-advertisement and hearing. ---PAGE BREAK--- Application Number: Revised 01/21/2022 Application for a Conditional Use permit in Pickens County, Georgia Application is hereby made to the Pickens County Planning Commission for the purpose of requesting a conditional use permit. (Please Print or Type) Applicant: (The applicant and/or representative must be present at all public hearings) Mailing Address: Phone Number: E-Mail: Are you the property owner? Yes No (If No, please complete property owner information below) Property Owner: Address: Phone Number: E-Mail: Agent or Legal Representative (If applicable): Address: Phone Number: E-Mail: In addition, 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. (Office Use Only) Conditional Use: Tax Map Parcel: Acreage: Conditional Use For: Street Address of Property: Submittal Date: Time: AM / PM Received By: Planning Commission Meeting Date: Commissioner Meeting Date: ---PAGE BREAK--- Application Number: Revised 01/21/2022 Property Information Street Address: City State Zip Code Directions to Property: Tax Map & Parcel Acreage: Land Lot(s): District: Section: Subdivision Name: Lot: Current Zoning: Current Use of Property: Has a conditional use permit of this property been requested in the past? If yes, provide case number: Surrounding Zoning: North: South: East: West: Property Access: Access to the development will be provided from: Road Name: Type of Surface: ---PAGE BREAK--- Application Number: Revised 01/21/2022 Requested Action and Details of Proposed Use Conditional Use Permit For: Proposed Access: Residential Number Lots: Minimum Lot Size: Restrictive Covenants? Yes No If yes, will all requirements be met? Yes No (circle one) (circle one) Sewage Type: Water Provider: Number Units: Density/Acre: Commercial & Industrial Building Area: Type of Business: Number of Parking Spaces: Lot Size: By signing below, I agree that the above information is true to the best of my knowledge. I understand that any incorrect or inaccurate information I willingly provide to the Planning and Development off may void my application. Further, I understand that any approvals given on the above-mentioned parcel by either the Planning Commission or the Board of Commissioners does not include any (if applicable) permissions and/or permit approvals from any and all required entities (County, State, Federal,) associated with the construction and operation of the requested use. Applicant’s Signature Date SIGN ---PAGE BREAK--- Application Number: Revised 01/21/2022 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--- Application Number: Revised 01/21/2022 APPLICANT CERTIFICATION I hereby request the action contained within this application relative to the property shown on the attached plats and site plan and further request that this item be placed on the Planning Commission agenda for a public hearing. I understand that the Planning & Development staff may either accept or reject my request upon review. My request will be rejected if all the necessary data is not presented. I understand that I have the obligation to present all data necessary and required by statute to enable the Planning Commission to make an informed determination on my request. I will seek the advice of an attorney if I am not familiar with the zoning and land use requirements. I understand that my request will be acted upon at the Planning Commission hearings and that I am required to be present or to be represented by someone able to present all facts. I understand that failure to appear at a public hearing may result in the postponement or denial of my variance request. I further understand that it is my responsibility to be aware of relevant public hearing dates and times regardless of notification from Pickens County. Name of Applicant or Agent: (Please Print) Signature of Applicant or Agent: Date: Mailing Address: City, State, Zip: Phone: E-mail: Signed in the presence of: (Planning and Development Administration Only) Signature: Date: I hereby withdraw application # Signature: Date: Withdrawal of Application Withdrawal of any application may be accommodated within the Planning & Development Office if requested before the Planning Commission agenda is set. Therefore, withdrawals may not be made after ten (10) business days prior to the scheduled Planning Commission meeting hearing, unless accompanied by written request stating specific reasons for withdrawal. This withdrawal request is to be published in the legal organ prior to the meeting. Following that written request and publication, the Planning Commission will vote to remove the item from the agenda at the scheduled hearing. Please note that should the withdrawal be denied, the item will receive deliberation and public hearing with a decision by the Planning Commission. Further, the applicant is encouraged to be present at the hearing to substantiate reasons for withdrawal. Please note that no refund of application fees will be made unless directed by the Board of Commissioners. WITHDRAWL NOTICE: This section only to be completed if application is withdrawn SIGN ---PAGE BREAK--- Application Number: Revised 01/21/2022 Pursuant to O.C.G.A. 36-67 A-3, any and all applications 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 Pickens 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. Circle One Board of Commissioners Yes No Planning Commission Members Yes No 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: Name: Amount/Value: Date: Description: Applicant’s Signature Date Signed and sealed in the presence of: Notary Signature My Commission Expires Place Notary stamp here ---PAGE BREAK--- Application Number: Revised 01/21/2022 Zoning Change PICKENS COUNTY NOTICE OF RESIDENTIAL – AGRICULTURAL DISTRICT (R-A) ADJACENCY Agricultural districts include uses of land primarily for active farming activities and result in odors, noise, dust, and other effects, which may not be compatible with adjacent development. Future abutting developers in non R-A land use districts shall be provided with this “Notice of R-A Adjacency” prior to administrative action on either the land use district to the issuance of a building or occupancy permit. Prior to administrative action the applicant shall be required to sign this waiver which indicates that the applicant understands that a use is ongoing adjacent to this use which will produce odors, noise, dust, and other effects which may not be compatible with the applicant’s development. Nevertheless, understanding the effects of the adjacent R-A use, the applicant agrees by executing this form to waive objection to those effects and understands that his/her district change and/or his/her permits are issued and processed in reliance on his/her agreement not to bring any action asserting that the adjacent uses in the R-A district constitute a nuisance against local governments and adjoining landowners whose property is located in an R-A district. This notice and acknowledgement shall be public record. Applicant’s Name (Please print) Applicant’s Signature Date Signed and sealed in the presence of: Notary Signature Place stamp/seal here My Commission Expires ---PAGE BREAK--- Application Number: Revised 01/21/2022 SIGNAGE AFFIDAVIT To ensure that the correct information is included on the public notice sign, Pickens County will prepare the sign for the applicant and will post the sign on the property. It is the applicant’s responsibility to ensure that the public notice is properly maintained for the duration of the application process. I am aware that the sign will be posted on the property. I authorize Pickens County to post the zoning sign on my property. Applicant’s Name (Please print) Applicant’s Signature Date Witness – Planning and Development Office Personnel ---PAGE BREAK--- Application Number: Revised 01/21/2022 FOR STAFF USE ONLY Conditional Use Application Applicant Name: Application Fee: Date Paid: Check/Card/Cash: Receipt If Applicable: Interdepartmental forms submitted for review Date: Georgia Mountains notified (DRI) Date: Department of Transportation notified Date: Adjacent property owner notices mailed Date: Public Notice signs on property verified Date: Legal advertisement emailed to newspaper Date: Planning & Zoning packets distributed Date: Applicant notified of final action Date: Approval or denial form placed in folder Date: Planning & Zoning meeting minutes in folder Date: Zoning Map amended – Tax Assessor notified of change Date: Approval or denial form placed in folder Date: Planning Commission meeting minutes in folder Date: Commissioners meeting minutes in folder Date: Planning & Zoning Recommendation Date: Approval Approval with conditions Denial Board of Commissioners Approval Approval with conditions Denial