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01/18/23
VARIANCE/WAIVER REQUEST FORM
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Plat Name 1 v
Owner:
Address:
Variance(s) Requested:
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R
Date Filed �� �' ; L
File No.
Engineer:
Address: tiI�L
dwj�'l' JKMW,�
(3
Justification:
Owner's Signature: V C.c.s 4 _ Date \7 Z
PL COMMISS ON CTfN:
r Date Y 8
Date
asis for Decision:__�e --
BOARD OF DIRECTORS ACTION:
Approval ( )
Denial ( ) Date!
Basis for Decision:
PLAINTIFF'S
EXHIBIT