CITY OF SHELBY, RICHLAND COUNTY, OHIO
APPLICATION NO.
APPLICATION FOR A VARIANCE
(File in Duplicate)
THIS APPLICATION WHEN PROPERLY APPROVED SHALL CONSTITUTE
A VARIANCE CERTIFICATE.
NAME OF APPLICANT
ADDRESS
PHONE NUMBER
LOCATION OF LAND FOR WHICH VARIANCE SOUGHT
ZONING DISTRICT
NATURE OF VARIANCE REQUESTED
SECTION OF ORDINANCE INVOLVED
GROUNDS UPON WHICH VARIANCE SHOULD BE GRANTED
Date Applicant Signature
ATTACH A SITE PLAN SHOWING:
BOUNDARIES OF PROPERTY
ABUTTING STREETS OR ROADS
EXISTING STRUCTURES
PROPOSED STRUCTURES
ACTION OF BOARD OF ZONING APPEALS
VARIANCE IS GRANTED/DENIED
Date Chairperson, Board of Zoning Appeals
City of Shelby