CITY OF FORT CALHOUN

Instructions: 
     1. Fill out application form completely. Please print or type and use additional sheets if needed. 
     2. Fee: $200.00 - Make check payable to the City of Fort Calhoun 
     3. Application due 14 days prior to next regular Planning Commission Meeting 
     4. Submit a certified address list of property owners within 300 feet with this application 
     5. Include Site Plan, drawn to scale (refer to Section 1204 (c) (4) of City Zoning Regulations

Applicant's Name: _________________________________________________________________________ 

Applicant's Address: __________________________________________________________Zip: __________ 

Telephone: (home): _________________________________ (work): _________________________________ 

Owner of Record: _________________________________ Address: _________________________________ 

Telephone: (home) __________________________________ (work): _________________________________ 

Present Zoning District of Property: ____________________________________________________________ 

Desired Zoning District of Property: ____________________________________________________________ 

Legal description of Property: ________________________________________________________________ 

Address of Property: _______________________________________________________________________ 

Description of the reason for the rezoning application: _____________________________________________ _________________________________________________________________________________________ 

Nature and Operating Characteristics of proposed use: ____________________________________________ _________________________________________________________________________________________ 

How are adjoining properties used? Indicate both zoning district designations and actual uses. 
North: ______________________________________ South: _______________________________________ 
East: _______________________________________ West: _______________________________________

This authorizes the City Planning Commission, City Council members and/or city staff/Consultant to enter 
upon the property during normal working hours for the purpose of becoming familiar with the proposed request.

________________________________________ 
Applicants Signature

_________________________________________ 
Property Owner's Signature