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BOA / APPLICATION FOR VARIANCE PERMIT NO._________

NAME OF PROPERTY OWNER (APPLICANT):______________________________________

ADDRESS:____________________________________________PHONE:_______________

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PROPERTY FOR WHICH PERMIT SOUGHT:

SIZE:________________________________________AREA:___________________S.F.

(ATTACH PLAT OR LEGAL DESCRIPTION OF PROPERTY)

ZONING CLASSIFICATION:______ ADDRESS:___________________________________

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USE:

( ) RESIDENTIAL ( ) COMMERCIAL ( ) INDUSTRIAL ( ) OTHER

ZONING DISTRICT:______________________________

DETAILS (SINGLE FAMILY RESIDENCE, DUPLEX, ETC., GROCERY, ETC., TYPE OF

INDUSTRIAL, ETC.)

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DESCRIPTION OF PROPOSAL, WHICH WOULD REQUIRE A VARIANCE:

_________________________________________________________________________

ATTACH A PLAN OF THE PROPOSED SITE FOR THE VARIANCE SHOWING THE LOCATION

OF ALL BUILDINGS, PARKING AND LOADING AREAS, TRAFFIC ACCESS AND TRAFFIC

CIRCULATION, OPEN SPACE, SIGNS, YARDS, AND OTHER SUCH INFORMATION AS

THE BOARD MAY REQUIRE TO DETERMINE IF THE PROPOSED VARIANCE MEETS THE

INTENT AND REQUIREMENTS OF THIS ORDINANCE AND IS APPROPRIATE FOR THE

LOCATION AT WHICH IT IS PROPOSED.

NARRATIVE STATEMENT OF PROPOSED USE & EVALUATION :

_________________________________________________________________________

_______________________________________ ________________________

SIGNATURE OF APPLICANT DATE

FEE: $16.50 DUE BEFORE ISSUANCE