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Step One

Zoning District*
Parcel ID #*
Date Submitted:*
Date Submitted:
Permit Fees:
Telecommunication (Tower) $500.00
Telecommunication Co-Location (Antennas) $200.00
No Fee for replacing existing Antenna(s)
Zoning District & Parcel ID can be found at the following link.
https://gis.greenecountyohio.gov/gims/
Type of Telecommunications Permit:*
New or Modification:*
Telecommunication Permits require one (1) full set of planned drawings to be attached below. *
Name of Land Owner:*
Phone*
Email*
Address*
Name of Applicant:*
Phone*
Email*
Address*
Surveyor certification required?*
1. Yes
2. No
Date Surveyor Certification Received:*
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I hereby certify that all of the information supplied in this application and attachments hereto are true and correct to the best of my knowledge, information and belief. I hereby consent to the inspection of the subject property, and of any buildings or structures to be constructed thereon, by the Township Zoning Inspector. I hereby acknowledge that I understand that if the construction or use described in the zoning certificate has not begun within six (6) months from the date of issuance, said zoning certificate shall become null and void.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Applicant Electronic Signature:*
Date:*
Date:
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Permit #
Upon the basis of Application the information contained within is made a part hereof, the proposed usage - 'Is' / 'Is Not' - found to be in accordance with the Township Zoning Resolution and is hereby - 'Approved' / 'Not Approved' -.
BZA Required?
1. Yes
2. No
BZA Case Number
Zoning Inspector/Code Enforcement Officer signature:
Permit Issued:
Permit Issued:

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