CN-2015-00217_0001-1.tif Filing Date (�'iy `� �/ Receipt Number 3 L
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APPLICATION FOR VARIANCE
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Applicant's Name Mailing Address Telephone
2.
Agent's Name Mailing Address Telephone
3.
Owner's Name _ Mailing Address Telephone
Address and Legal Description
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Describe t e reques a ariance
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State briefly your reasons and hardship for request (Use Back if Necessary)
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Signature of Bldg. Inspector Date Signature of Owner(s) Date
DO NOT WRITE BELOW THIS LINE
BOARD OF ADJUSTMENT HEARING ACTION
1. Carried to Roll Yes No
2. Not Carried to 1. Coo 1 c/
Date of Notice � I (�1 2•
Date of Public Hearing 3• eVlr�er - I�� t/
Date Approved " Ica I I L4 4• 0(15101 �
Date Not Approved 5. 'Q�
Recommendation .N nn(0 e as o fe 6.