"Board of Variance Bylaw, 1982, No. 1919"
BOARD OF VARIANCE APPLICATION

Bes it
A Netaodt aod ital,
cine Uae ie
fs

i;
en

Name
Phone Numoor

Mailing Address

(Pleane enaure that this
‘address is marked on the.

property)

- Current Use of Property

Proposed Uae of Property

Date of Purchase

‘

: Details of Refusal or Hardship.

(Sea Second Paga)