TANEY COUNTY PLANNING COMMISSION
P. O. Box 383 • Forsyth, Missouri 65653
PIJOII<:417546-7225/722q • Fax: 417546-6861
emnil:gregsfYco.ta1Iey.mo.us • website: wJVlV.tancycounty.org
APPLICATION FOR CONCEPT
DIVISION III
TANEY COUNTY PLANNING COMMISSION
The Concept Application is for the use of the Planning Staff and Commission to
enable us to know the nature of the planned project. The official Division III
Application for permit will be filed along with everything needed to complete
your file, as listed on the Division III Procedure Checklist. Division III
Applications: $100.00, Special Use Applications: $25.00.
NAME OF PROJECT: N ~\A/ L :'fJc..o ~Oc(. k lAy? \A..--fA.II-e. ~o~e,e
NAM E OF APPLICANT: 'IS (' \. '" V\ e:.. \AI" e ( I W\. 0 V'\
(Must be owner ofrecord)
SIGNATURE: DATE: 3 -30 -0 ~
(Must be owner ofrecord)
MAILING ADDRESS: PrO, (60)( bOr l)fl\.I1I.SO\l\, MO 65615
TELEPHONE NUMBER: ~\ \ J - 33> Y - 3 0 0 .,
Representative Information
NAME OF REPRESENTATIVE: , " , 'vV\ QIA." '" ff\ - G e"' ...... \ A'j r
MAILING ADDRESS (rep.): f,O, bo)< 60 \ 6,,\"'~"', MO bSb\5
TELEPHONE NUMBER (rep.): lI. n - 13 i..\ - ?:'OUI ~"F-+ 'd...O'"
Revised 12/19/03
Property Information
ACCESS TO PROPERTY (street # and name): J.. 16M"" ",etc l\"\ ~f ~ V'€.
K-...d:;,t',,:J Ie I MD (,S(,lq
Number of Acres (or sq. ft. of lot size): _\.:....:d--::....::...._"'.:....:c.:....:v--=€.:.:::.5 _
PARCEL #: I 1 - f .0 - lOt -6bd.- - OD I ----cQ I ,DLrD
(Parcel if MUST be on pennit. Example: 00-0.0-OO-OOO-OOO-OOO.000. This number is on top left ...."" comenf
property tax statement. If you ....ve not paid taxes on property, must ........ name of preYious owner of property.)
SECTION: .....I--"';{.'-,- TOWNSHIP: _t?e..t2e>..- RANGE: ----'d""-L-/_ _
NAME OF SUBDIVISION (if applicable): _
Lot # (if applicable) ,BLOCK # _
WITHIN 600' FROM THIS PROPERTY IS:
(Check all land uses that apply)
iElCommercial 0 Multi-Family ~~sidential 0 Agricultural
o Multi-Use . 0 Municipality
SEWAGE DISPOSAL SYSTEM:
o TreatmE:!nt Plant ~dividual
~tral Sewer: District #~
c
WATER SUPPLY SYSTEM:
o Community Well () 0 Private Well
~ntral: District # i~(<.)Si:J ~d
DOES THE PROPERTY LIE IN THE 100-YEAR FLOOD PLAIN? 0 Yes 0 No
THIS REQUEST FALLS INTO ONE OR MORE OF THE FOLLOWING
CATEGORIES:
o Residential o Multi-Family ~Commercial 0 Industrial
o Special Use o Other - Explain: _
Revised 12/19/03
Anyproposedproject that does not have a posted 911 address must be identified
with a survey flag at the proposed access to the property. Failure to post the
survey flag will result in a delay ofthe Public Hearing. Please give a description of
yourproposedproject including all uses: (IMPORTANT: Make this description as
complete as possible as your public notice will be based on the information
provided here.)
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tl' r <. r "'-\- \ 0 " S ......... " \ b <2. .. Revised 12/19/03
04/06/2009 08:19 4173343010 upeD PAGE 02/03
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