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ciTT OP attomo - vautiAPCi applzcatioh <br />Initial Application Pao $175.00 <br />($50.00 por aach additional varianca) <br />Ranaifal Varianca Faa $100.00 <br />(no changa from original application) <br />Aftar*tha-Pact Faas (Doubla application faa) <br />PMPttTT LOCATZOa <br />#1 <br />Sita Addraaa (/(i '■)rr ^ kJ <br />Proparty Idantification Numbar (P.I.D.).^O /I "7 ^3?3c0^i <br />J~ct <br />Attach lagal description to application if not included on <br />required survey. <br />APPUCAVT <br />Name ( <br />Phone (h<t) <br />'' //k D <br />Address i .16 6- T 4,/ <; r tj l^/( <br />_ _ _ Phone (woric) <br />City I // vT Zipi 3^. <br />(if different than applicant) <br />Name _ _ _ <br />Phone (home) <br />Phone (wor)c) <br />Address s Citys Zips, <br />Date Property Acquired _ <br />I (do) tdo no^ also own the adjacent parcels of land. <br />(month/year) <br />PKXsnr on or psomiTr <br />Present Zoning District <br />Present Use of Property ♦—'Residential <br />Other (specify) <br />DISCRIPTKM OP UQOB8T Estimated Construction Cost $ / <br />Describe request in details A(\D ^ <br />VARZAMCB8 UQOIKBD <br />_ _ _ Lot Area <br />Setbac)c Variances (, <br />Other _ _ _ _ _ _ _ _ <br />Lot Width <br />Front <br />X_ _ Hardcover <br />Side _ __ Rear)