Variance Request Form

Date:

Lot # :

Section:

Name of Property Owner(s):

Mailing Address:

Phone Number # 1:

Phone Number # 2:

Email:

Name of Applicant (if different than owner)

Mailing Address:

Phone Number # 1:

Phone Number # 2:

Email:

Note in detail the circumstances that make it necessary to request a variance:

Note the specific provisions or sections of the PEPOA rules and regulations and/or the Protective Covenants that are involved in this request:

Describe the nature of the variance you are applying for:

Please list any reasons why you feel this request should be granted:

Note any unique physical circumstances, if any, which are creating the hardship, claimed:

Other circumstances that make it necessary for you to request a variance:

Were you in any way responsible for creating the hardship claimed?

Will the variance, if granted, alter the character or impair the use of adjacent properties?

Does the variance requested represent the minimum relief and the least modification possible?

Include below any additional information deemed relevant to this application:

Date

Signature of Owner:

If you will not be present for your hearing but will have someone there representing you, please give us the following information:

Name of Representative:

Mailing Address:

Phone Number # 1:

Phone Number #2:

Email

The above named person is authorized to represent me, my property and my interests before the Penn Estates Architectural Review Board.

Attach Any Supporting Documents:

Maximum file size: 10.49MB

Date

Signature of Owner:

Received By:

Date

Completed Variance Application

Homeowner’s Signature

Notified ARB Chair

Created Packet for Meeting

Letter of Notification of Meeting Sent to Applicant

APPLICATION FOR A VARIANCE FORM