6. Current use:______________________ Zone:____________________
7. Basis for request: ______________________________________________________
8. Name, Address & Phone number of land owners abutting this property
and directly across the street:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
9. Does this request violate protective covenants?_________________________________
10. Has request been previously filed? ___________Yes ___________No,
Date: ___________
11. Adjacent land use: _______________________________________________________
12. Certified Plat of the property from a Registered Surveyor submitted
with payment of fee
___________Yes___________No:
to be submitted: _________________________________
13. Authorization of the Board, relative to this request expires six months
from the date of the decision.
Fee: $150.00___________Cash___________Check___________Other.
Date: ___________
Case No.___________is scheduled for hearing by the Board of Zoning Adjustment
___________
at ___________ o'clock p.m. in the Council Chambers of City Hall in Scottsboro,
Alabama.
Signatures:
_____________________ ______________________ ______________________
Owner
Applicant City
Planner