1/22/08

APPLICATION FOR VARIANCE

TO: ZONING BOARD OF APPEALS APPLICATION #_______________

of the TOWN OF BERNE PARCEL ID #__________________

BERNE, NY 12023 DATE________________________

BUILDING & ZONING DEPARTMENT ACTION

DENIED__________

REASON_____________________ _____________________________ _____________________________ _____________________________

DATE:

Signed by:_________________________________

The Undersigned hereby applies for a variance from the requirements of the ordinance of the Town of Berne entitled ZONING ORDINANCE TOWN of BERNE in the following respects:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The specific provision of said ordinance involved is:

________________________________________________________________________________________________________________________________________________

State the grounds within the framework of the Town of Berne Zoning Ordinance for granting or denying the application:

________________________________________________________________________________________________________________________________________________________________________________________________________________________

Additional Information Required

The name and address of the undersigned is:

________________________________________________________________________________________________________________________________________________

The name and address of the owner of the zone lot affected is:

________________________________________________________________________

________________________________________________________________________

(OVER)

A brief description and location of said lot is:

________________________________________________________________________________________________________________________________________________

The present zoning classification of said lot, the improvements thereon and the present use thereof is:

________________________________________________________________________________________________________________________________________________________________________________________________________________________

An accurate description of the improvement or additions or changes intended to be made, indicating the size of such proposed improvements, material and general construction thereof:_________________________________________________________________________________________________________________________________________________________________________________________________________________

A plot plan in triplicate of said lot drawn to scale must be attached, indicating the location and size of the lot, the location and size of improvements thereon and the location and size of improvements proposed to be erected thereon. The applicant shall enclose in triplicate any substantiating evidence.

Dated this _____day of__________,20__ _________________________________

Signature of Applicant

Name and address of attorney or agent if

Applicant is to be so represented:

_______________________________

_______________________________

_______________________________