HomeMy WebLinkAboutVariance-Waiver Request Formsubd.doc 5
01/18/23
VARIANCE/WAIVER REQUEST FORM
Date Filed
Plat Name File No.
Owner:agiaaert' ` 7yi•✓! �C.✓buGY�d—%�F'EIPt/T1�
Address: 1 ✓17 �'it+'ST P6 Address: I i,t7Ffiia�(f�
Phone: Phone: O 1 —1 , 34:i� z- C91 31 Z - ve-7 Z
Variance(s) Requested:
(1)
Owner's S
PLANNING COMMISSION ACTION:
Approval( ) Date
Denial ( ) Date
Basis for Decision:
BOARD OF DIRECTORS ACTION:
Approval ( ) Date
Denial () Date
Basis for Decision: