Special Exception Application - Anne Arundel County
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1For Office Use Only
For Office Use Only
ZONE _________
CASE # _________________________
CRITICAL AREA: IDA ___ LDA ___ RCA ___
FEE PAID_______________________
BMA: Yes ____ No ____
DATE ___________________________
NO. OF SIGNS ____________
SPECIAL EXCEPTION APPLICATION
NOTE: This form can be downloaded to your computer and filled out utilizing Adobe Reader (or similar product). It can also be printed and filled
out by hand.
Applicant(s):_______________________________________________________________________________________
(Applicant must have a financial, contractual, or proprietary interest in the property)
Property Address: __________________________________________________________________________________
(Enter Street Name )
Property Location: _______ feet of frontage on the (
) side of __________________________________ ;
N, S, E, W
(Enter Street Name )
_________ feet (
) of (Nearest intersecting street) ______________________________________ .
N, S, E, W
12-digit Tax Account Number ____________________________ Tax District (
Council District
)
(
)
_______
______
Waterfront Lot: Y
N
Corner Lot: Y
N
Deed Title Reference ____________________
Zoning District ________
Lot # _________ Tax Map ________ Block/Grid _______ Parcel _____________
Area ______________ (
Sq Ft, or Acres
) Subdivision Name ____________________________________________
Description of Special Exception Requested (Brief, detail fully in letter of explanation)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
The applicant hereby certifies that he or she has a financial, contractual, or proprietary interest equal to or in excess of 10 percent of
the property; that he or she is authorized to make this application; that the information shown on this application is correct; and that he
or she will comply with all applicable regulations of Anne Arundel County, Maryland.
Applicant’s Signature ___________________________ Owner’s Signature ____________________________________
Print Name ___________________________________ Print Name __________________________________________
Mailing Address _______________________________ Mailing Address ______________________________________
City, State, Zip ________________________________ City, State, Zip ________________________________________
Phone ________________________________________ Phone ______________________________________________
(Work)
(Home)
(Work)
(Home)
Cell Phone ____________________________________ Cell Phone __________________________________________
Email Address _________________________________ Email Address ________________________________________
* * * Below For Office Use Only * * *
Application accepted by Anne Arundel County Office of Planning and Zoning: _______________________________________
Initials
Date
Special Exception to __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Rev 06/15/16
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