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2. Please Allow 2-3 business days for your request to be completed.

4. Part 1: Information about the requestor
6. First Name*
7. Last Name*
9. Mailing Address*
11. City
12. State
13. Zip Code
15. Email Address*
16. Phone Number
20. Information about the subject property and its proposed use
22. Street Address or Location of the Subject Property
24. City
25. State
26. Zip Code
28. The Legal Description of the Subject Property

    The Subdivision, Square, and Lot(s) are MANDATORY fields.  The legal description of the property can be obtained by contacting the Jefferson Parish Assessor's Office at 504-362-4100.

30. Subdivision*
31. Square*
32. Lot(s)*
34. Previous Use (If Known)
36. Detailed Description of the Proposed Use:*
38. Will you be storing any materials on site?*

    1. Yes
    2. No
40. If you answered yes to the above question please check all that apply

    1. Cement, lime, gypsum or plaster of paris manufacture or storage
    2. Fuel gas storage (not service stations or gas stations)
    3. Fuel gas distribution station
    4. Gasoline storage and wholesale distribution (Does not include service stations or gas stations)
    5. Gas manufacture
    6. Gravel pits
    7. Land and gravel storage yard
    8. Oil, gas and mineral exploration
    9. Refining of petroleum or its products
    10. Sand and gravel pits
    11. Sand blasting as a primary occupation
    12. The production and/or storage of red label chemicals and products as defined by the Occupational Safety and Health Administration (OSHA)
    13. Vulcanizing and galvanizing shops
    14. Any other similar use which would by objectionable or obnoxious because of danger from radiation, explosion or because the emission or creation of smoke, dust, fumes, odors, gas, noise, vibration or similar conditions
    15. Other (Specify below)
42. Specify other materials indicated above
46. ACKNOWLEDGEMENTS

    By signing this form below, you agree to the following:

    -I acknowledge that a zoning verification is not a permit to change, alter, renovate, repair, or remodel, including building, mechanical, plumbing, or electrical.

    -I acknowledge that this preliminary zoning verification should not be used as a basis for the purchase of property, final building design, or any other important legal or financial decisions regarding an intended use of the property.

    -I acknowledge that all zoning and building code requirements must be met prior to occupancy.

48. 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.
50. Electronic Signature
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field