Application No. _________
To the _________[Board of Zoning Appeals or Board of Adjustment or as the case may be]
A. Statement of Ownership and Interest.
1. The applicant(s), _________[name(s)], _________[is or are] the owner(s) of property situated at the following address: _________
2. The legal description of the property is as follows: _________
3. The applicant(s) acquired the above-described property on _________[date].
4. The _________[applicant’s or applicants’] telephone number is _________.
The _________[applicant requests or applicants request] the following variance(s):
1. Section(s) of Zoning Ordinance concerned: _________
2. Description and purpose of use restriction(s) sought to be varied: _________[for example: (a) Reduction in front set-back requirements from 35 feet to 28 feet, and (b) increase in unit density for apartment buildings from 1000 square feet to 300 square feet].
3. Statement of variance sought: _________[for example: To obtain a waiver of the uses permitted in residential zone R-1 by permitting three-family occupancy of the subject property and to obtain a waiver of all provisions set forth in the Denial of Certification or Building Permit as required to permit the proposed construction, as shown on the attached plan drawn to scale].
C. Reasons for Request.
1. _________[State reasons in separately numbered paragraphs, for example: The strict application of the above-referenced provisions of the Zoning Ordinance would result in practical difficulties or unnecessary hardship inconsistent with the general purpose and intent of the Zoning Ordinance of the _________ (Town or City) of _________.
2. The exceptional or extraordinary circumstances or conditions applying to the _________ (property involved or intended use of the property involved or intended development of the property involved) that do not apply generally to other properties or uses in the same zoning district or neighborhood are _________(specify).
3. The granting of the variance(s) sought will not be a substantial detriment to the public interest or to the property or improvements in the zoning district concerned, and will not materially impair the purpose of the Zoning Ordinance of the _________ (Town or City) of _________ because _________(specify).]
4. Section of Zoning Ordinance proposed for amendment: _________
5. Proposed amendatory wording: _________
6. Circumstances or changed conditions that justify the proposed amendment: _________
7. The proposed amendment will clarify or improve the ordinance for the following reason(s): _________