This application must be filled out completely and returned no less than three (3) weeks prior to a scheduled Board of Appeals hearing. All mailings will be sent to the applicant.

Applicant: _____________________________________________________________________

Address: ______________________________________________________________________

Telephone: ____________________________________ Fax: ____________________________

Owner (If Different than Applicant): __________________________________________________

Address: ______________________________________________________________________

Telephone: _____________________________________ Fax:____________________________

Subject Property:

            Address: ________________________________________________________________

            General Location: __________________________________________________________

            Legal Description: (Attach if Necessary) _________________________________________

            ________________________________________________________________________

            ________________________________________________________________________

            ________________________________________________________________________

            ________________________________________________________________________

____ Variance Request

____ Ordinance or Map Interpretation

_____ Appeal from Administrative Decision

Description of Request (Attach Additional Sheets if Necessary):

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

• Can this property be put to a use which conforms with the Zoning Ordinance without a variance?

Yes No

• Is the problem requiring a variance unique to this property?

Yes No

• Is the problem due to general conditions in the neighborhood?

Yes No

• If the request is granted, will the essential character of the neighborhood be changed?

Yes No

• Is the situation causing the need for the variance self created?

Yes No

A site drawing roughly to scale, indicating lot lines, existing buildings and structures, easements and other relevant features must accompany this application. This drawing shall indicate all relevant lot, structure and spacing dimensions.

I hereby grant personnel involved with the review of this request permission for reasonable entry onto the above property for investigations specifically related to this request.

I further understand that if the requested appeal is granted, I am in no way relieved from all other applicable requirements of the Zoning Ordinance or other applicable regulations.

Applicant’s Signature: _________________________ Date: ________________________

Owner’s Signature: ___________________________ Date: ________________________