THIS WORKSHEET TO BE COMPLETED BY THE APPLICANT


Name of Applicant:_________________________________   Home Phone:______________________
Address:__________________________________________  Business Phone:____________________
             ___________________________________________ Cell Phone:________________________

Name of Owner of Record:____________________________ Home Phone:______________________
Address:___________________________________________ Business Phone:____________________
                        Cell Phone:________________________
Address of the Property:________________________________________________________________
                                                           (if different from Applicant's current address)
Parcel Number________________

Provide documentation as to authority to file notice of appeal (e.g. deed, power of attorney, lease, or purchase agreement)

Provide a legal description of the property, as recorded with the Geauga County Recorder


PROVIDE THE FOLLOWING:

The current zoning district in which the property is located:
   Residential _____      Commercial _____      Manufactured Home _____      Industrial ____

The description of the existing use of the property: __________________________________________

Provide a description of the proposed use of the lot:__________________________________________

The proposed use of the property:
   _____New Construction        _____Remodeling        _____Accessory Building           _____Other         
   _____Residential                   _____Business              _____Industrial                           _____Sign

                                       
PROVIDE TWO (2) COPIES OF A PLAN OR MAP, DRAWN TO SCALE, WITH A NORTH ARROW AND DATE SHOWING THE FOLLOWING INFORMATION.

Dimensions (in feet) of all property lines:
N__________  S__________  E__________  W__________     Acreage: _____________