Ford County Planning, Zoning
APPLICATION
and Environmental Health Rezone___ Conditional Use___ Development Plan ___
100 Gunsmoke, Dodge City, Ks. 67801 Office Use Only
Phone: (620) 227-4670
Parcel#_________________________________
Fax; (620) 227-4717
1/4      Section     Township     Range
1. Owner Information Applicant/Agent Information (if different)
Name of applicant Name of applicant
Mailing address Mailing address
City                                     State            Zip code City                                     State            Zip code
Telephone#                             Email address                     Telephone#                Email address

2. The applicant hereby requests: (please check one)
               _______ a Rezone from________________ Zoning District to ____________________Zoning District.
               _______ a Conditional Use permit and/or a Development Plan approval for the purpose of:

3. For general location is described as:
                Lot(s)_____Block(s) _______of the __________________________________________Addition
           OR
                On the ________(N, S, E, W) side of ______________________Street/Road between ___________
               (Street/Road) and _____________________________(Street/Road)
           OR
               (if existing): Address: ___________________________________________ 

Legal description: _______________________________________________________________________________________
Legal property descriptions shall
be provided in this space____________________________________________________________________________________
or on an attached shee
                              _______________________________________________________________________________________
In flood plain?       

4. I request approval for the following reasons: (Do not include reference to proposed uses for rezoning.)
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

5. Proposed landscaping on property (attach sheet if necessary): ________________________________________________________________________________________

I (we), the applicant(s), acknowledge receipt of the instructions explaing the method of submitting this application. I (we)
understand that this applciation cannot be processed unless is is completely filled in, has owner's signature, and is accompanied
by the appropriate fee.

______________________________________________         _____________________________________
Owner                                                                                  Date      
______________________________________________         _____________________________________
Owner/Authorized Agent (if any)                                             Date
   

OFFICE USE ONLY:
This application ws received at the office of the Zoning Administrator at ___(AM, PM) on ___day of ______, 20____.
It has been reviewed and found to be complete and accompanied by the required documents and the appropriate fee of______.

________________________________________________           __________________________________________
Name                                                                                         Title