Fill and Sign the Zoning Board of Appeals New York State Department Form

Detailed Application to a Zoning Board For Variance From Zoning Restriction with a Plot Plan Showing Block and Lot Numbers and Existing as well as Proposed Structures Application No. __________________________ To: The ___________________________________________________________________ (Name of Zoning Board) Application is made by ___________________________________________________ (Name of Owner) for a variation from the requirements of ______________________________ (Citation of applicable section of zoning ordinance) of the Zoning Ordinance of the ____________________________________ (Name of City) pursuant to the statutory power vested in the Board, to permit the premises identified below to be used as (e.g., assisted living apartments) ___________________________________________________________________. The premises affected are situated at ________________________________________________ _____________________________________________________________________________________________ (street address, city, county, state, zip code) , being Tax Parcel No. ________ as shown on the tax map of the City of _________________________________ (Name of City). Applicant is the owner of the said premises, and resides at _______________________ _______________________________________________________________________________________________ (street address, city, county, state, zip code) . Description of (Proposed or Existing) Building 1. Size of building: a. At street level: _________________________________________________. b. Height: _________________________________________________. 2. Occupancy (of each floor): _____________________________________. 3. Zoning district: _________________________________________________. 4. Year of construction: _________________________________________________. 5. Character of construction: (e.g., stone, brick, hollow tile, stucco, etc.) ______________ ________________________________________________________________________ 6. There has been no previous application concerning these premises. 7. The premises (e.g., are or are not) ___________________________ located in proximity to a school or a hospital. (Note: If near a school or a hospital or both, indicate how close) . _________________________________________________________________ 8. The applicant does not rely on a nonconforming use. 9. The proposed use is not prohibited by ordinances of the City of ____________________ (Name of City) other than the Zoning Ordinance. Attached to and made a part of this Application, Applicant submits the following attachments: A.A plot plan showing block and lot numbers, and existing and proposed structures with necessary dimensions indicating yard spaces and adjoining structures. B. A statement of the proposed points on which the Applicant bases his Application, with a description of proposed work.C. A ground and typical floor plan of the building with all necessary measurements.D. Affidavit of ownership. Witness my signature this the __________________________________________ (date). ___________________________ _______________ __________________________________________ (Signature and Printed Name of Owner/Applicant) Attachments