CITY OF FORT CALHOUN
SPECIAL USE PERMIT APPLICATION

Instructions:
         1. Fill out application form completely.  Please print or type.  Use additional sheets if needed.
         2. Filing Fee: __________________.  Make check payable to the City of Fort Calhoun.
         3. Contact Planning Commission Chairman if you have any questions.
         4. Submit a list of property owners within 1,000 feet.

Applicant's Name: ________________________________________________________________________

Applicant's Address: ______________________________________________________Zip: ____________

Telephone: (home): _____________________________ (work): __________________________________

Owner of Record: _____________________________Address: ___________________________________

Telephone: (home) _____________________________ (work): ___________________________________

Present Use of Property: __________________________________________________________________

Desired Use of Property: __________________________________________________________________

________________________________________________________________________________________

Present Zoning: _________________________________________________________________________

Legal description of Property: _____________________________________________________________

Address of Property: _____________________________________________________________________

Under what provisions of the Fort Calhoun Zoning Regulations are you seeking this permit?

 _______________________________________________________________________________________ 

Duration of Special Use Permit? __________________________________________________________ 

Explain in detail what you propose to do: __________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ 
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 and Building Inspector to enter upon 
the property during normal working hours for the purpose of becoming familiar with the proposed 
situation.

Applicants Signature  __________________________________________________________________ 

Property Owner's Signature  ____________________________________________________________ 

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