Application For A Hearing Before The Development Review Board Form - Town Of Elmore Page 4

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The undersigned hereby request an appearance before the Development Review Board for the land
development described above. Any permit issued as a result of this application shall be null and void in the event
of misrepresentation or failure to undertake construction within one year from approval.
__________________________________
_________________________________
____________
Signature of Owner
Signature of Applicant
Date Submitted
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
For Administrative Use Only:
Date Filled with Zoning Administrator: ________________
Date of First Review by Development Review Board: ____
Notice of Hearing: ____________________
Notice Surrounding Landowners: _______________________
Date of Hearing(s): _______________
_________________
_________________
__________________
Date of Decision: _______________ Approved: ___________ Denied:_
On the bases of the following findings of facts and conditions attached
to the permit, see minutes of: _______________
_______________
________________________________________________
_____________________________________
Zoning Administrator
Date
________________________________________________
_____________________________________
Chair, Development Review Board
Date

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