I (WE) of

, HEARBY APPEAL TO THE ZONING BOARD OF APPEALS FOR

1. LOCATION OF THE PROPERTY:

2. DESCRIPTION OF CASE: (Fill out only items that apply.)

1. Present zoning classification of the property:
2. Description of property:
   a. Size of lot:
   b. Area of lot:
   c. Is lot a corner or interior lot? CornerInterior
3. Description of existing strcutures:
   a. Number of buildings now on premises:
   b. Size of each building now on premises:
   c. Use of existing buildings on premises:
   d. Percentage of lot coverage on ground level:
4. Description of proposed structure:
   a. Height of proposed structure:
   b. Dimensions of building or addition to be constructed:
   c. Area of building or addition to be constructed:
   d. Percentage of lot coverage of building or addition:
5. Yard setbacks after completion of building or addition:
   a. Front yard (measured from lot line):
   b. Side yard (measured form lot line:
   c. Rear yard (measured from lot line):
6. A sketch depicting the above information shall accompany this application (This sketch shall be on a sheet of paper 8 1/2 x 11" in size.)
7. Reason for appeal.
   a. Interpretation of the Zoning Ordinance is requested because:
   b. A special permit is requested pursuant to Article ,
   Section , Paragraph , of the Zoning Ordinance because:
   c. Variance to the Zoning Ordinance is requested for these reasons:
   1. The property in question is not physically suitable for use under the limitations of the zoning district in which it is located because:
   2. The hardship created is unique and is not shared by all properties alike in the immediate vicinity of this property and in the use district because:
   3. the variance would not change the character of the district because:
8. Article and Section number of Zoning Ordinance that is being appealed: