Board of Zoning Adjustment Appeal Application

2. Type

   1. Conditional Use Permit
   2. Variance
   3. Building Inspector's Interpretation

3. Notes

5. Application Date
   Application Date

6. Hearing Date
   Hearing Date

8. Appeal Number

9. Zoned

11. Property Address

13. City

14. State

15. Zip Code

17. Requirements
    These items are required:<br>1. Site Plan<br>2. Adjacent Property Owner's Names and Addresses<br>3. Application Fee of $40<br>4. Land Use Restriction Filing Fee of $16 (refundable if appeal denied)

    These items are required:
    1. Site Plan
    2. Adjacent Property Owner's Names and Addresses
    3. Application Fee of $40
    4. Land Use Restriction Filing Fee of $16 (refundable if appeal denied)

21. Property Owner Name

23. Address

25. City

26. State

27. Zip Code

29. Phone Number

30. Fax Number

32. eSignature of Property Owner

    By typing your name, 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.

33. Date
    Date

37. Transmitted by: (Name of Code Administrator)

38. Date
    Date

40. Received by: (Name of Secretary, Board of Zoning Adjustment)

41. Date
    Date

43. Decision

45. Date File in County Clerk's Office
    Date File in County Clerk's Office

46. Applicant Requirement
    Applicant must be present at Board of Zoning Adjustment meeting.

    Applicant must be present at Board of Zoning Adjustment meeting.

50. Notes

52. Date Letter Mailed to Applicant
    Date Letter Mailed to Applicant

53. Date Letter Mailed to Adjacent Property Owner(s)
    Date Letter Mailed to Adjacent Property Owner(s)

Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field