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Applicant's Information

State of Iowa, County of Floyd (34)
Board of Adjustment
Request for Conditional Use
Number
Date*
Date
Applicant's Address*
City*
State*
Zip*
Phone Number*
E-Mail*
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Zoned District*
(Ag, residential, commercial, etc)
Quarter*
Section*
Township Name*
Township Number*
Range*
Other Description
Lot Number
Block Number
Subdivision
Size of Lot*
Width*
Depth*
Front Setback
(Feet from right-of-way line.)
Reat Set-In
(Feet from property line.)
Structure Height
Number of Feet From Side Property Line
Please specify which side property line.
Number of Feet From Side Property Line
Please specify which side property line.
Requested Use*
Please include as much information as possible. We may contact you for more information.
Associated Fees
There is a nonrefundable application fee of $150. Make checks payable to Floyd County Treasurer.
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Certification
The undersigned applicant certifies that the forgoing information is true and correct. Applicant hereby agrees to pay the costs of this process and publication of same as required by ordinance.
Signature of Applicant or Agent
Date
Date
Other Requirements
This application must be accompanied by:
- A list of names and mailing addresses of property owners within 500 feet in all directions from the perimeter of this property
- Sketch of existing or proposed facilities
- Dimensions of same and distances from property lines
- Application may be accompanied by letters of support or objection of surrounding property owners or other interested parties
Official Use Only
Status
1. Approved
1. Denied
Fee Accepted
1. Yes
1. No
Floyd County Zoning Administrator Signature

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