NEW BUFFALO TOWNSHIP For Office Use Only

17425 Red Arrow Hwy Fee ________________________________

New Buffalo, Michigan 49117 Receipt No. _________________________

(269) 469-1011 Fax (269) 469-6711 Date Rec. __________________________

Hearing Date ________________________

Township Board Action: _______________

___________________________________

___________________________________ Date: ______________________________

Tax Code: __________________________

APPLICATION FOR SPECIAL LAND USE PERMIT

IDENTIFICATION

APPLICANT:

Name ____________________________ Telephone _________________________

Address ___________________________ City/State/Zip ______________________

Please Note: All questions must be answered completely. If additional space is needed, number and attach additional sheets. The total number of attached sheets __________.

1. PROPERTY INFORMATION

1. Legal description of property: _________________________________________

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2. Address of Property: ________________________________________________

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3. Describe adjacent property uses: ______________________________________

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_____________________________________________________________________

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2. ACTION REQUESTED

It is hereby requested that the New Buffalo Township Board approve the issuance of a Special Land Use Permit for the property described above which is located in zoning district ___________________

For the purpose of (state proposed use of property) __________________________

_____________________________________________________________________

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A previous application for a variance, special land use permit or rezoning on this land has/has not (choose one) been made with respect to these premises in the last year. If a previous appeal, rezoning or special land use permit application was made, state the date, nature of action requested and the decision:

Date: ____________________ Action Requested: ___________________________

_____________________________________________________________________

_____________________________________________________________________

Decision (approved/denied)

3. AFFIDAVIT

The undersigned affirms that he/she or we, is/are the (specify owner, lessee, or other type of interest) _______________________________________________________

_____________________________________________________________________

_____________________________________________________________________

involved in the application; and that if the request is granted, the actual construction will be done so in accordance with Chapter 15 Special Land Uses of the New Buffalo Township Zoning Ordinance. The applicant(s) agree to allow New Buffalo Township Officials, individually, access to the property for which this application is made for the purpose of viewing the site. The answers and statements herein contained and the information herewith submitted are in all aspects true and correct to the best of my/our knowledge and belief.

Applicant Signature(s) _______________________________

_______________________________

_______________________________

Date

Owner Signature(s) _______________________________

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Date