HomeMy WebLinkAboutVariance Request Form 011725subd.doc 5
01 /18/23
VARIANCE/WAIVER REQUEST FORM
Date Filed
Plat Name File No.
Owner: 5e09— Engineer: 47 /1I
Address: S-1122 >r*&i *Lw Address: 7AP WfS
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Phone: !S!bl • f Mt6 -%f Z i Phone: z(C
Variance(s) Requestcd: t �
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Justification
PLANNING COMMISSION ACTION: BOARD OF DIRECTORS ACTION:
Approval ( ) Date Approval( ) Date
Denial () Date Denial ( ) Date
Basis for Decision: Basis for Decision: