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City of Mildred
Specific Use Permit
Application Only


Application fee of $75.00 and a Administrative fee of $25.00


Date____________                                                


Applicant Name: ___________________________________________


Address: _________________________________________________


Job Address: ______________________________________________

Applicant Interest in Property:
(  ) Owner   (  ) Option   (  ) Agent   (  ) Lease   (  ) Other
Description of property: (Legal description may be attached)
_________________________________________________________


Lot No. ____   Block:___- 

911 Address: ____________________________________________


Name Deed Recorded In: __________________________________________________


Proposed use of property: ______________________________________________________________________


Present Zoning: __________________________________________________________


Are there deed or subdivision restrictions which could prevent this property from being used in the manner herein proposed?    (  ) Yes        (  ) No

Are there any proposed exterior changes that would possibly be objected to by adjacent property owners?
(  ) Yes    (  ) No

Have all persons having any financial interest in the request been listed or are signatories to this application?


(  ) Yes    (  ) No

  _______________  _______________________________
          Date:                     Signature of owner/Applicant: