CERTIFICATE OF ZONING COMPLIANCE / OCCUPANCY

ANTELOPE COUNTY, NEBRASKA

This portion to be filled out completely by applicant.

The undersigned hereby applies for a Certificate of Zoning Compliance / Occupancy to occupy and use the premises as follows:

1. Legal description of the property to be affected by the activity proposed: ______________________.

2. Proposed use of premises: ___________________________________________________________.

3. I hereby certify that I have the legal authority to file this application, that I have competed and examined this application and know the same to be true and correct.  I further certify that all provisions of law and other regulations governing the type of construction and use proposed in this application have been complied with, whether or not specified in this application.

4. A Certificate of Zoning Compliance/ Occupancy, once issued, shall remain in effect so long as the use of the land, buildings and structures are used in accordance with said Certificate.

________________________________                                     _______________________________

Printed name of applicant(s)                                                                                       complete mailing address of applicant(s)                        

________________________________               _________________           ____________________

Signature of applicant(s)                                                                   date of application                         phone #  of applicant(s)

This section to be completed by Zoning Administrator

CERTIFICATE OF ZONING COMPLIANCE/OCCUPANCY APPLICATION NO. _________

                This certificate is issued to _____________________________ and

                                dated ___________________________.

1.  If proposed occupancy is a change of use where no new building or additions are proposed and no zoning permit is needed, said building and use will comply with all setback distances, water/sewage disposal requirements, parking/sign regulations and other applicable zoning regulations (refer to requirements on permit)                    YES        NO           N/A

2.  If proposed occupancy is a change of use where a new building or addition is proposed and a zoning permit is needed, said building and use will comply with all setback distances, water/sewage disposal requirements, parking/sign regulations and other applicable zoning regulations (refer to requirements on permit).                YES        NO       N/A

3.  Has building permit been issued, and if so, building and proposed use complies with all conditions of          approval?              YES      NO

4. If use required a Conditional Use approval, building/use complies with all conditions of approval.

                 YES       NO     N/A

5. If use required approval of a Variance by the Board of Adjustment, such use complies with all conditions of approval of the approved variance.        YES     NO     N/A

6. Site inspected on _________________ to verify compliance with all applicable conditions.

7. Inspector’s comments: _________________________________________________________________________________.

8. Certificate of Zoning Compliance/Occupancy issued on _____________________.  

                                           ___________________________________ Zoning Administrator

 Copy of approved Certificate of Zoning Compliance /Occupancy mailed to applicant on ____________________.

revised 3-25-02