ZBA Property Owner Authorization to Submit Application

ZBA Property Owner Authorization to Submit Application
Project Information
Project Name*
Address of Subject Property*
Tax Parcel ID Number(s) of Subject Property:*
Name of Authorized Applicant*
Please identify the types of applications for which you are granting authorization. (Select all that apply).*

HDC-Certificate of AppropriatenessIWA-Inland Wetlands LicenseIWA-Inland Wetlands and Watercourses Map AmendmentPZC-Alteration to Scenic RoadPZC-Modification to Approved PlansPZC-Site Plan ReviewPZC-Special PermitPZC-SubdivisionPZC-Zoning Map AmendmentPZC-Zoning Text AmendmentZBA-VarianceZBA-Special ExceptionZBA-Claim of Zoning Agent Error
Property Owner Information
Property Owner Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Owner Telephone*
Please enter a valid phone number.
Property Owner Email*
example@example.com
Owner Certification Statement
In authorizing the submission of this application, I hereby certify the following:
- I am the property owner of record and have authorized the submission of the above-referenced applications.
- I consent to necessary and proper inspections of the subject property by members and agents of the respective Agency, Board, or Commission that is reviewing the application at reasonable times, both during the application review process and post-decision, should the application be approved. I further understand and consent to the presence of the public on the property as part of any publicly noticed field trip of the Agency/Board/Commission to the property.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

ZBA Property Owner Authorization to Submit Application

Project Information

Property Owner Information

Owner Certification Statement