Request for Exemption Form - Non AG

Jefferson Twp. Zoning Department
28 S. Main St. POB 115
Jeffersonville, OH 43120
REQUEST FOR EXEMPTION FROM ZONING

1. Application Info

MM slash DD slash YYYY
Owner's Name(Required)
Owner's Address(Required)
Property Location(Required)
I the owner of the above described property respectfully request that the property be exempt from zoning. We believe the structure is exempt for the following reasons.(Required)
Owner's Signature(Required)
MM slash DD slash YYYY
Consent(Required)
This field is hidden when viewing the form

Admin Section (Zoning Officials)

This field is hidden when viewing the form
Reviewed By:
This field is hidden when viewing the form
Upon review the Exemption from Zoning code is hereby:
This field is hidden when viewing the form
MM slash DD slash YYYY
This field is hidden when viewing the form
This field is hidden when viewing the form
Clear Signature
This field is hidden when viewing the form

Appeal Section

Zoning Inspector

Automatic Fee Calculation.
Based on your answers, the form will calculate exactly what you owe.

Secure Stripe Checkout.
Enter payment info right after you submit. We accept all major credit/debit cards.

Instant Confirmation.
You’ll get an email receipt and a copy of your completed form, ready for your records.