Ford County Planning, Zoning	APPLICATION
	and Environmental Health
	100 Gunsmoke, Dodge City, KS 67801	Rezone _____     Conditional Use ____    Development Plan _____
	Phone:  (620) 227-4670	Office Use Only
	Fax:  (620) 227-4717	Parcel #:
	http://www.fordcounty.net		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 sheet
In flood plain?
4.  I request approval for the following reasons:  (Do not include reference to proposed uses for rezoning.)
5.  Proposed other developments  and improvements on property		(outline in development plan):
I (we), the applicant(s), acknowledge receipt of the instructions explaining the method of submitting this application.  I (we)
understand that this application cannot be processed unless it is completely filled in, has owner's signature, and is
accompanied by the appropriate fee.
Owner			Date
Owner / Authorized Agent (if any)			Date
Rev. #1 12-01-06, MAS
OFFICE USE ONLY:
This application was 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