Action Requested:   Special Exception Interpretation Variance Appeal

Applicant's Name 

Mailing Address

Applicant's Attorney/ Representative Name (if any):

If Interest is Other Than Owner,
Furnish Name And Address of Owner

Property Location: (19)/ Zoning District:

Present Use

Interpretation, Conditional Use, Special Exception or Variance Sought

Reasons/Grounds For Seeking Appeal As Indicated Above

For An Appeal, Variance Or Interpretation, Attach A True Copy Of The Order, Requirement, Decision or Determination of the Zoning Office.

Date Name

 
Signature

For Official Use Only

Date Application Was Received by Township ______________ Fees Received _________ Check or Cash ________

Publication Date _____________ Notices Posted _____________ Hearing Date______________

Planning Commission Action _________________________ Zoning Hearing Board Action __________________________

Note: This application must be accompanied by a detailed site plan indicating property boundaries, relation to existing streets or roads, building, etc., proposed buildings, parking areas, landscaping or screening, lighting, signs, etc. This plan shall include all necessary dimensions, including yards and North shall be indicated by an arrow. All information submitted supporting this application shall become a part of the record and cannot be returned (refer to Section 1400.7 of the Township of Tobyhanna Zoning Ordinance).

Rev. 10/06