Application for Variance from Zoning Restrictions



Board of Appeals on Zoning

City of _________

_________[address]

Application for Variation From the Requirements of the Zoning Ordinance

Names and Addresses

Applicant: _________

Address: _________

Owner: _________

Address: _________

Lessee: _________

Address: _________

Location: _________

Avenue: _________ Block: _________

.........................................................................................................  

Lot: _________

 

(As shown on the tax map of the City of _________)

To the Zoning Board of Appeals:

Application is made for a variation from the requirements of Section _________ of the zoning ordinance, under the discretionary power vested in that board, to:

Permit the premises to be used as _________[state use, such as: a boarding home conducted by a practical nurse or a convalescent home].

Premises affected are situated at _________[address], _________[city], _________ County, _________[state], and known as _________.

Description of Proposed or Existing Building

(1). Size of building: _________.

At street level: _________.

Height: _________.

(2). Occupancy (of each floor): _________.

(3). Zoning district: _________.

(4). Date of erection: _________.

(5). Character of construction: _________[explain construction, such as: stone, brick, hollow tile, stucco, fire-retarding].

(6). Inside or outside fire limits? _________.

(7). Has there been any previous application or appeal on these premises? _________.

(7a). If so, state result: _________.

(8). Is there a school or hospital within _________ feet or in same block on either side of the street? _________.

(9). Does appellant rely on a nonconforming use? _________.

(10). Is the proposed change or use prohibited by ordinances of the city other than the zoning ordinance? _________.

Attached hereto and made a part of this application, applicant submits the following:

(a). A plot plan showing block and lot numbers, and existing and proposed structures with necessary dimensions indicating yard spaces and adjoining structures when required.

(b). A statement of the principal points on which applicant bases his application, with description of proposed work, if any.

(c). A ground and typical floor plan of building with all necessary measurements.

(d). Affidavit of ownership.

Dated: _________

[Signature of applicant]

[Attachments]