APPENDIX C APPLICATION FOR CONSIDERATION OF A MODIFICATION

The undersigned hereby applies for approval of a Modification / waiver, submitted herewith and described below:

   1.   Title of Plan:                                                                                                                                          

Plan No.:                                                         Plan Date:                                                                            

   2.   Specific Section of the Subdivision and Land Development Ordinance for which a

Modification is requested:                                                                                                                        

The Proposed Alternative to the Requirement:                                                                                      

Justification for the Modification / Waiver:                                                                                             

The undersigned hereby represents that, to the best of their knowledge and belief, all information listed above is true, correct, and complete.

                                                                                                                                   ,  20

Signature                   Date

For Borough Use Only:

File No.                                                                                                                     

Date of Receipt / Filing:                                                                                            

Planning Commission Meeting Date:                                                                      

Borough of Marysville Meeting Date:                                                                     

(Ord. 614, 5/11/2015)