OWNER/AGENT STATEMENT

          I, _________________________, being the Owner or Agent acting on behalf of the owner request that the attached rezoning request of ______________________ be placed on the agenda of the Planning Board meeting scheduled for _____/_____/_____.

          I certify that all of the information presented by me in this application is accurate to the best of my knowledge, information, and belief. I authorize the City of Washington to place a sign on the property in question for the purpose of alerting the general public of my request, no less than seven (7) days prior to the meeting.

          I understand that failure to address any item in these requirements may result in the rezoning not meeting the minimum submission requirements and will be returned to me for revision and resubmission at the next regular review cycle.