HomeMy WebLinkAboutVariance Request Form 062724subd.doc 5
VARIANCEAVAIVER REQUEST FORM
Date Filed /. / /71Z
01/18/23
Plat Name z �/ File No.
Owner:
Address: Address:
Phone: Phone:
V'
(1
(2)
Justifrcad
PLANNING COMMISSION ACTION:
Approval ( ) Date
Denial () Date
Basis for Decision:
BOARD OF DIRECTORS ACTION:
Approval ( ) Date
Denial () Date
Basis for Decision:
r