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APPLICATION FOR A VARIANCE FORM
Application for a Variance
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:
Clear
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:
Drop a file here or click to upload
Choose File
Maximum file size: 10.49MB
Date
Signature of Owner:
Clear
DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY
Received By:
Date
Completed Variance Application
Homeowner’s Signature
Notified ARB Chair
Created Packet for Meeting
Letter of Notification of Meeting Sent to Applicant
Submit
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PEPOA