Polk County District Change Application Page 3
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3Please list all names and complete mailing addresses of all adjoining property owners within 300 feet (including across
the road). Provide property address if known.
Name
Mailing
Address
Property Address
Name
Mailing
Address
Property Address
Name
Mailing
Address
Property Address
Name
Mailing
Address
Property Address
NOTE: This application will not be processed until all information required has been provided. Once we receive your
application, it takes at least 4-6 weeks to process your application. You will receive a notice by mail, indicating when the
hearing will take place. The applicant or a representative must attend the hearing.
The Polk County Land Information Committee members will receive information regarding your request before the
scheduled hearing date. Decisions by the Committee are generally made immediately following the applicant’s hearing.
Final approval from the County Board is also required if the Committee recommends granting your petition to rezone.
CONTACT YOUR LOCAL TOWNSHIP FOR ADDITIONAL REQUIREMENTS
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