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cm or oRoao - vmiaikb APPLxcikTioii <br />Initial Application Paa $175.00 <br />($50.00 par aach additional varia: <br />Ranaval Varianca Faa $100.00 <br />(no change from original applicati' <br />Aftar-tha-Pact Fees (Double application faa) <br />#1568 I1 <br />PROPBRn LOCATIOH ^ <br />Sit. Addr... Hot yRf <br />Property Identification Number (P.I.D.) <br />Attach legal description to application if not included on <br />required survey. <br />APPLZCAHT <br />Name <br />Addresst <br />Phone (home).'4Tt"uVt~ <br />Zip: <br />Phone (home) <br />_ _ Phone (work) <br />Addre... WA H<M1 ,S«n lODOfcitv. kiM. Z <br />(if different than applicant) <br />Name 6IM MtOPOO <br />SC4n. <br />Date Property Acquired (month/yaar) <br />I (do) (d^^t) also own the adjacent parcels of land. <br />PRBSniT USB OF PROPBRTT <br />Present Zoning District <br />Present Use of Property Residential <br />Other (specify) <br />DESCRIPTION OF RBQOBST Estimated Construction Cost $_________ <br />Describe request in detail»fltetfT <br />VARIAl RBQOIRBD <br />Lot Area Lot Width <br />Setback Variances ( <br />Other _ _ __ <br />_ _ Hardcover <br />side Rear)