SCHEDULE "A"

"Board of Variance Bylaw, 1981, No. 1919"
(as enacted by Bylaw No. 2615)

“BOARD OF VARIANCE APPLICATION

NAME OF OWNER

NAME OF APPLICANT
: (If Different From Owner)

.

MAILING ADDRESS

Postal Code

Phone No.

(if Different From Above)

LEGAL DESCRIPTION | |
- _° . (Lot)

_ CURRENT USE

| DATE OF PURCHASE

t

| DETAILS OF REFUSAL OR HARDSHIP (Reason for Board of Variance Appeal):

u

NOTES Co . | -Sfgnature of Owner.

see instructions | oat 7 aoe

on next page — | : 1. a -

arn . ‘Signature of Applicant
Gf different from owner)