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cm OP OROHO - VRRIAIICB APPLICATION <br />Initial Application Fee $175.00 <br />($50.00 par each additional variance <br />Renewal Variance Fee $100.00 <br />(no change from original application) <br />After-the-Pact Pees (Double application fee) <br />PROPERTY LOCATION <br />Site Address <br />Property Identification Number (P.I.O.) <br />#1484 <br />cijy CF cRm <br />Fim'E (FFICE <br />1350200000 <br />. 01 m 150.i)>) <br />im 71 150 (<{! <br />^tCEIPT-Tim tw <br />H164030 COOl r<0l <br />Attach legal description to application if not included on <br />required survey. <br />APPLICANT.r <br />Name <br />Phone (home) ^*7V£> <br />__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone (wofltS^ ^7 Z, *3 <br />Address:n ^Ty^citvt _ _ _ zip:_ _ _ _ _ <br />/ <br />ONNBR (if different than applicant) Phone (home) <br />\^\nnlrx^\\ LOKi^-q^ Phone (work)Name \ ul Y > rx <br />Address: ^ City: (jQojt^Zgcf^ Zip: <br />Date Property Acquired ^Jp^P^_ _ _ _ _ _ _ _ _ (month/year) <br />I (do) Uonot)\ also own the adjacent parcels of land. <br />PRESENT USE OF PROPERTY <br />Present Zoning District /Of'/TTOD <br />Present Use of Property _ _ _ _ _ _Residential <br />other (specify) <br />OESCRIPnOM OF REQUEST <br />Describe request in detail: <br />Estimated Construction Cost $ <br />Describe request in aetaii:(^l Q ^^rran rr\txc4~\cig_ <br />VARIANCES R] <br />Lot Area <br />Setback Variances ( <br />Lot Width <br />Front <br />Hardcover <br />Side Rear) <br />Other Q\rA 4-W^A \qo r’.ffi^aLC pd <br />(as pAT Oro-r.o G>PB'd'^S^