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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:
    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. Applicant Requirement
    Applicant must be present at Board of Zoning Adjustment meeting.
49. Notes
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

* indicates a required field