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2. Applicant Information
4. First Name*
5. Last Name*
7. Street Address*
9. City
10. State
11. Zip Code
13. Phone Number*
14. Email Address
16. Are the owners of the referenced real estate other than the applicant named above?

    1. Yes
    2. No
20. Is this joint tenancy?

    1. Yes
    2. No
22. First Name of Property Owner
23. Last Name
25. Address
27. City
28. State
29. Zip Code
33. First Name of 2nd Property Owner
34. Last Name of 2nd Property Owner
36. Address
38. City
39. State
40. Zip Code
44. First Name of 3rd Property Owner
45. Last Name of 3rd Property Owner
47. Address
49. City
50. State
51. Zip Code
53. Is applicant or owner incorporated?*

    1. Yes
    2. No
55. If yes, list the names addresses of officers, directors and holders of stock or shares in excess of 20%
57. Is this for a business applicant?*

    1. Yes
    2. No
59. If yes, list the true and actual name and address of the owner.
61. Is this a partnership or voluntary association syndicate?*

    1. Yes
    2. No
63. If yes, list the names and addresses of all owners.
65. For entities governed by governing boards, attach a copy of the Board Resolution or Board Minutes authorizing the governing board’s approval to carry out the requested project, and to authorize the submission to the City by a designated entity officer of the specific request/application, is required to be submitted as an attachment.
67. List the designated person(s) that will represent (spokesperson) the owner/applicant along with contact information.
69. List the legal representative (licenses to practice law in the State of Illinois) of applicant (if any).
71. First Name of Legal Representative
72. Last Name of Legal Representative
74. Street Address
76. City
77. State
78. Zip Code
80. Phone Number
81. Email Address
83. List the number of the ordinance, particular section of the ordinance etc., which allows your request.
85. What is the legal address and postal address of the real estate named in the application for a zoning change amendment?
87. Street Address
89. Street Address 2 (PO Box)
91. City
92. State
93. Zip Code
95. Has this matter been presented to the Planning Commission before?

    1. Yes
    2. No
97. If yes, what were the results?
99. Are there any zoning requirements or other regulations that are currently or will be presented to another board, commission or agency etc. that may affect your request that is being presented before the Planning Commission?

    1. Yes
    2. No
101. If yes, please explain.
103. Reason for request giving proposed use of property if special use permit is granted
105. Person or persons to occupy property under proposed variance and their relationship to the owner.
107. Is a mobile home or other existing structure involved in the request?

     1. Yes
     2. No

     If yes, mobile home or structure must be inspected by the Building Inspector.
109. Mobile Homes must conform to the standards in Illinois Mobile Home Safety Act. No mobile home shall hereafter be brought into this municipality unless said home conforms to the construction safety standards adopted by the State of Illinois in the Mobile Home Safety Act, Ch. 67 1/2 Ill. Rev. Statue, 501-515/1. (Now 430 ILCS 115/1 vi sec) The Illinois Manufactured Housing and Mobile Home Safety Act went into effect July 1, 1974, and mobile homes manufactured before that date do not comply with its provisions.
111. If there will be new construction, has the Building Inspector of the City of Litchfield been issued copies of the planned construction?

     1. Yes
     2. No

     An inspection by the City Building Inspector of the property named in the application will be required.
113. If no, please explain.
117. The real estate named in the application for zoning change must be properly posted according to Ordinance of the City of Litchfield.

119. Real estate must be posted; public notice must be published 1 time, not more than (30) days nor less than (15) days prior to the public hearing of the Planning Commission. Petitioner must purchase from the City Clerk a minimum of two public notification posters concerning the application; one to be posted at City Hall and the other on the property for which the zoning change is being requested.

121. An inspection fee and a filing fee of $110.00 will be required with the return of this application to the Office of the City Clerk, City of Litchfield, Montgomery County, Illinois.
123. Name
     Inspection & Filing Fee
124. Price
125. Quantity
126. Shipping Cost
128. Taxable
130. Petitioners may want to prepare maps, drawings, and plans or use photographs in presenting the application to the Planning Commission.
132. Signatures of neighboring property owners may be presented at the hearing, and should be presented for signature as follows:

134. Signatures must include property owners of property on all four sides: North, South, East and West, of the block on which the property is located, as well as the signatures of all property owners on the opposite side of the street immediately facing said property. Other signatures from the area are acceptable as well.

     "I have no objections to the City of Litchfield granting a special use permit as requested above."

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