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					                  ROCKINGHAM COUNTY ZONING APPEAL APPLICATION
                                           FOR OFFICE USE ONLY

       FEE: _____________                                    DEADLINE DATE: __________________
       RECEIPT # ________                                    HEARING DATE: ___________________
       DATE REC ________


                                             BZA #______________



APPLICANT: _____________________________________________________________________________

ADDRESS: _______________________________________________________________________________


CONTACT PERSON: __________________________________ Daytime No. ________________


LOCATION: (N S E W) side of Route # _______ approximately _____ miles/feet (N S E W) of Route # _____
           in the __________________ Magisterial District, Election District # ______.

TAX MAP # ________________________ ZONING: ____________                      ACRES: ____________


TO THE BOARD OF ZONING APPEALS:

I (We) respectfully request that the Board of Zoning Appeals decide our appeal for an interpretation/decision of
the Zoning Administrator made on __________________, 20___.

I (We) appeal ___________________________________________________________________________

_______________________________________________________________________________________

for the following reason(s): __________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________


A previous appeal on this (has/has not) been filed on this property. My (Our) interest in this property is as
(owner, lessee, contract purchaser).

If applicant does not own property, the landowner's signature must be obtained.


__________________________                                           __________________________
  Signature of Landowner                                                   Applicant or Agent

				
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