The undersigned hereby applies for a zoning permit as per Article VI Zoning Chapter XIII, for the following use to be issued on the basis of the representation contained herein, which the applicant swears to be true.
NAME OF LAND OWNER:
NAME OF APPLICANT:
RESIDENCE: Number of families:
Please attach a survey of the lot, showing public roads, existing buildings and proposed construction or use for which this application is made, known as a Plot Plan, should accompany this application
Date Applicant Signature