Whenever a legislative body approves a zoning map amendment, whenever
the Planning Commission approves a development plan or subdivision plat,
and whenever the Board of Adjustments approves a variance or conditional
use permit, a certificate of land use restriction as shown on the following
page shall be filed with the County Clerk (per KRS 100.3683).

1. Name and address of property owner(s).
_____________________________ ____________________________________
_____________________________ _____________________________________
_____________________________ _____________________________________
 

2. Address of Property                      3. Name of Subdivision or development
                                                             (If  applicable)
____________________________ ______________________________________
____________________________ ______________________________________
____________________________ ______________________________________
3. Name of Subdivision or development (If  applicable)

4. Type of Restriction(s) (Check all that apply)
______Zoning Map Amendment to_______Zone
______Conditional Zoning Condition
______Development Plan
______Subdivision Plan
______Variance
______Conditional Use Permit
______Other (Specify)______________________________
.
5. Name and address of Planning Commission, Board of Adjustment, legislative body which maintains the original records containing the restriction.
_____________________________________
_____________________________________
_____________________________________
 

___________________________
Signature of Completing Official

___________________________
Name and Title of Completing
Official (type or print)
(Ord. 920.27, passed 10-7-93) 

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