Petition for Concept & Preliminary Plan Review_Vill of Buffalo Grove (1)VILLAGE OF BUFFALO GROVE
PETITION FOR CONCEPT AND PRELIMINARY PLAN REVIEW
PLEASE NOTE THAT THIS PETITION MUST BE SIGNED BY ALL PROPERTY OWNERS AND THE PETITIONER. IF PETITIONER HAS
ANY QUESTIONS CONCERNING REQUIRED MATERIALS, PLEASE CALL THE DIVISION OF PLANNING SERVICES AT 847-459-2525.
Project Name:
Site Address:
Title:
Date of Submittal:
INDEX INFORMATION (To be completed by Village staff)
Petitioner:
Corporation/ Title:
Street Address:
BACKGROUND INFORMATION
City/ State/ ZIP:
Cell:Telephone (Office):
Relationship of Petitioner to Property (e.g. Contract Purchaser, Lessee, Owner):
Owner Name:
Corporation/ Title:
OWNER OF PROPERTY (If a Trust, see attached Beneficiary Disclosure Form)
City/ State/ ZIP:
Cell:
Street Address:
Telephone (Office):
PROJECT STAFF (As applicable)
Email:Fax:
Fax:Email:
Name:
Developer
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Name:
Attorney
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Page 1 of 4Form last revised January 2014
Site address:
PROJECT/ SITE INFORMATION
APPROVAL REQUESTED (Check all that apply)
Site Plan/ Preliminary Plan Special Use PUD Annexation
Rezoning Appearance Review
Variation
Landscape Plan Other
Name:
Engineer
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Name:
Architect
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Name:
Landscape Architect
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Name:
Traffic Consultant
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Name:
Other
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Name:
Other
Company:
Address:
City, State, ZIP:
Phone (Office):Cell:
Fax:Email:
Page 2 of 4
Legal description:
(If description
exceeds more than
eight type-written
lines, submit as an
electronic file in
Word format)
FILLING FEES:
All applications require payment of a non-refundable fee. Please see the Fee Schedule at the Village website under Home/
Government/Planning and Economic Development/Applications and Forms/Fee Schedule.
In addition to filing fees, an escrow deposit for the Village's recoverable costs is required. Questions concerning fees can be directed
to the Village Planner at (847) 459-2525.
I certify that the above is true and accurate and agree to pay the required fees as stated in Fee Schedule.
CHARACTER OF SURROUNDING AREA
North
South
East
West
VARIATIONS:
List all variations requested of Village Ordinances. The specific section of the respective Ordinance should be cited, and the reason(s)
that the variation is needed should be clearly explained.
Proposed structures (sq. ft. and building height):
Significant natural amenities, including trees:
Floodplains and other development restrictions:
Zoning/ Jurisdiction Land Use
Signature of Petitioner Date
Page 3 of 4
Proposed uses:
Proposed zoning: Current zoning:
Existing structures:
PIN number (s):
Current land use:Existing uses on site:
Size of parcel:sq.ft.acres
Size of building:sq.ft.Size of user/tenant space:sq.ft.
Signature of Property Owner Date
Page 4 of 4
Trustee Signature :
Beneficiary Signature :
SUBSCRIBED AND SWORN TO
before me this day of , 2014
Notary Public
SUBSCRIBED AND SWORN TO
before me this day of , 2014
Notary Public
BENEFICIARIES OF LAND TRUST #
For any property held in a land trust, state law requires all beneficiaries of the trust be identified by name, address, and interest in the
subject property. In addition, the application must be verified by the trustee or beneficiaries. In the event the beneficiary of a land
trust is a corporation, the corporation shareholders must be identified.
Name of Beneficiary Address Interest in Property
TRUSTEE NAMES
Address:
Telephone: Fax:
BENEFICIARY DISCLOSURE FORM (LAND TRUSTS)