APPLICATION FOR A VARIANCE

INSTRUCTIONS

Print or type clearly. Use additional sheets if necessary. All required attachments shall be submitted with this application form. Incomplete or inaccurate applications may delay decision dates. The completed application package must be submitted to the County [appropriate county staff member] by the subdivider or a designated agent and shall be in compliance with the requirements of the County Subdivision Regulations. Each application must be accompanied by the required administrative fee.

APPLICANT INFORMATION

1. Subdivider Name_________________________________________________________________________
   Address______________________________________________________________________
    Phone Number __________________________________
   Signature _______________________________________________ Date ____________________________

2. Engineer/Surveyor Name____________________________________________________________________
  Address______________________________________________________________________
  Phone Number ___________________________________ 
  Signature _________________________________________ Date ________________________

SUBDIVISION INFORMATION

3.  Name of Subdivision _______________________________________________________________________

4. Reason for Variance (brief description) _________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Attach a copy of the planned development program containing maps, schematics, and a narrative statement describing the full build-out of the proposed development.

PROCEDURAL INFORMATION  (To be completed by County Staff)

6. Date application received by County __________________________  Signed _______________________________

7. Date of public hearing _______________________________________