Borough of Delmont
77 Greensburg Street, Delmont, PA 15626
(724) 468-4422 Fax: (724) 468-4356
Notice of Appeal to the Zoning Hearing Board
Name of Appellant:
Address:
Phone: Fax: Email:
Location of Property: Lot Size:
Tax Map No.: Zoning District:
Present Improvements on Property:
Present Use: Proposed Use:
Date, Circumstances and Appeal Number of any prior application affecting this property:
I hereby request that a determination be made by the Delmont Borough Zoning Hearing Board as to the following: Appeal from determination of the Zoning Officer
Request for an interpretation of the Zoning Ordinance or Zoning Map
Special Exception in accordance with the terms of the Zoning Ordinance
A dimensional Variance as more specifically set forth below
A Variance from the provisions of Ordinance Section as more specifically set forth below
I believe that the Zoning Hearing Board should approve this request because:
(Specifically set forth the nature of your request, the grounds for relief, and the reasons both with respect to law and fact for granting the requested relief. Attach additional sheets as necessary.)
(Other items which may be necessary for the filing of this application or the granting of relief include: survey and/or site plan of property showing all structures and required yard setbacks; blueprints of the interior; written evidence of past applications; and any other information or evidence you wish the Board to consider.)
I hereby certify that all of the above statements and the information set forth on any papers or plans submitted herewith are true and correct to the best of my knowledge and belief.
Date:
Signature
BOROUGH ACTION
Appeal No.: Fee Paid $ Date Filed:
Date of Hearing: Posting Date: Ad Dates:
Zoning Officer
Action of the Zoning Hearing Board:
Date of Decision:
Zoning Hearing Board Chairman