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Planning & Development 1266 East Church Street Hall C Jasper, GA 30143 [PHONE REDACTED] [EMAIL REDACTED] Rezoning 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: Application to Amend the Official Zoning Map of Pickens County, Georgia (Office Use Only) Zoning Change: Tax Map Parcel: Acreage Being Zoned: REZONING FROM: TO: Street Address of Property Being Zoned: Submittal Date: Time: AM / PM Received By: Planning Commission Meeting Date: Commissioner Meeting Date: Application is hereby made to the Pickens County Planning Commission for the purpose of proposing to amend the Official Zoning Map of Pickens County, Georgia. (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: Location of Property: Land Lot(s): District(s): Section(s): Acreage: County Tax Map & Parcel Number: Revised 1/21/2022 ---PAGE BREAK--- Application Number: 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. 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: **By signing this application, I acknowledge that if my rezone request is approved, an official plat must also be submitted to Planning and Development for approval before submittal to the Clerk of Courts Office for recording. I further acknowledge that all minor and major subdivision re-zones are also subject to approval by Environmental Health and Pickens County Water Department and not part of the rezone approval. Applicant’s Signature Property Owner’s Signature (If Different) Signed and sealed in the presence of: Notary Signature Date Date My Commission Expires Place Notary stamp here Revised 1/21/2022 SIGN SIGN SIGN ---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) Revised 1/21/2022 ---PAGE BREAK--- Application Number: 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 Revised 1/21/2022 SIGN SIGN ---PAGE BREAK--- Application Number: 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 Revised 1/21/2022 SIGN SIGN ---PAGE BREAK--- Application Number: SIGNAGE AFFIDAVIT In order 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 Revised 1/21/2022 SIGN ---PAGE BREAK--- Application Number: FOR STAFF USE ONLY Rezoning 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: Zoning Map amended – Tax Assessor notified of change Date: Planning Commission meeting minutes in folder Date: Commissioners meeting minutes in folder Date: Planning & Zoning Meeting Date: Approval Approval with conditions Denial Board of Commissioners Meeting Date: Approval Approval with conditions Denial Revised 1/21/2022