HARRISON COUNTY PLAN COMMISSION

COUNTY OFFICE BUILDING 124 SOUTH MULBERRY CORYDON, INDIANA 47112

TELEPHONE 738-8927

APPLICATION FOR A CHANGE IN ZONING FROM THE REQUIREMENTS OF THE HARRISON COUNTY ZONING ORDINANCE

DOCKET # ____________

DATE FILED __________

NAME OF APPLICANT_________________________________________________________________

ADDRESS OF APPLICANT:_________________________________________________________________

OWNER OF PROPERTY IN QUESTION:__________________________________________________________________

ADDRESS OF PROPERTY OWNER:_____________________________________________________________________

DESCRIPTION OF SITE IN QUESTION- ATTACH DEED.

REQUESTED ZONING FOR PROPERTY:______________________________________

OTHER INFORMTION:_______________________________________________________

HAS AN APPLICATION FOR A CHANGE IN ZONING HEREINTOFORE BEEN FILED WITH THE COMMISSION FOR THE SITE IN QUESTION? If so, give date___________

SIGNED:

(Applicant)_______________________________

OWNER_________________________________

AGENT__________________________________

PHONE NUMBER________________________

FEE: $75.00