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Application for Appeal to the Board of Adjustment

2. I am applying to the Board of Adjustment for a:*
   -- Select One --Special ExceptionVariance to a rule
4. This appeal is for an adjustment of Ordinance Number
6. Section Number
8. Variance Request*
10. First Name*
11. Last Name*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
21. Legal Description:
23. Addition*
24. Block*
25. Lot*
27. Address of Property*
29. Zoning District of property
30. Name of Property Owner
32. Special Permission is Hereby Requested for the Following Reasons
34. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
36. Electronic Signature
40. Fee
    Fee: $20
41. Cash Receipt Number
43. Date
    Date
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field