Zoning Appeals Form

TOWN OF HOLLAND
Variance/ Special Permit Application

This Form To Be Filed with the Town Clerk with Fee Payment of $125.00

                                                                                                                                          Date ______________________

TO THE ZONING BOARD OF APPEALS:
The undersigned hereby petitions the Board of Appeals to vary the terms of the Zoning By-Laws of the Town of Holland

in the following respect:     due to a ______non-conforming lot
or          ______other reason please explain:

Please give Chapter and Section of the Zoning By-Laws for which a variance is requested:

or any limitation, extension, change, alteration or modification of use, or method of use as may at the hearing appear as necessary or proper in the premises.

For the following property:  Street_____________________________________________________

Map & Lot Number _______________________________

State Briefly Reason for Variance
Attach Pertinent Plans & Drawings

Property Owner____________________________________________

Petitioner__________________________________________________

Address___________________________________________________

Phone______________________________________________