City of West Branch
121 North 4^th Street West Branch, MI 48661
(989) 345-0500
(Please print, complete & return to City Hall at address listed above)
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Zoning Application

Date: ____________

Name: _____________________________________

Address: _________________________________________________________

Phone Number: __________________________

If application is by other than owner of property involved, state interest(s) in property and authority to apply for requested action on reverse side of this form.

           Action Requested:
Appeal Proceeding     -    $150.00 fee
Ordinance Amendment -  $150.00 fee
Special Use Permit    -     $150.00 fee

Property description_____________________________________________________

Property address_______________________________________________________

Reason for request*_____________________________________________________

*Attach site plans and other supporting evidence for request.

I certify that to the best of my knowledge and belief the foregoing statements are true and correct.

                                                                                         ______________________________
Signature

For Office Use Only

Fee Paid $:__________________                       Disposition: _________________
Date Paid:___________________                       ___________________________
Received By:_________________                       ___________________________