Form 1 - Request For A Hearing - Zoning Board Of Appeals County Of Horry, South Carolina Page 4
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9Request for a Hearing – Form 1
Zoning Board of Appeals
County of Horry, South Carolina
Date Filed: ________________
Permit Application No.: _______________
Appeal No.: ___________
Instructions
This form must be completed on a hearing on appeal from action of a zoning official, application for a
variance, special exception or a reconsideration request. Entries must be printed or typewritten. If the
application is on behalf of the property owner(s), all owners must sign. If the applicant is not an owner, the
owner(s) must sign the Designation of Agent. The following shall be required:
1. An accurate, legible plot plan prepared by a registered architect, engineer or surveyor showing property
dimensions and locations of all structures and improvements must be attached to an application for
variance.
2. Verification of the tax map number for the property in question by the County Tax Assessor’s Office.
3. Filing fee of $200.00
THE APPLICANT HEREBY APPEALS
! from an action of a zoning official as stated on attached Form 2
! for a variance as stated on attached Form 3
! for a special exception as stated on attached Form 4
! for a reconsideration as stated on attached Form 5
APPLICANT/AGENT’S NAME:_____________________________________________________________________
Address: ____________________________________________________________________________________
City,State,Zip:_______________________________________________________________________________
Telephone: ____________________________(work) _____________________________(home)
Interest: _______________ Owner(s) ____________Adjacent Owner(s)
Other:__________________
PROPERTY OWNER(S) [f other than Applicant(s)]:______________________________________________________
Address: ____________________________________________________________________________________
City,State,Zip: _______________________________________________________________________________
Telephone: ___________________________(work) ______________________________(home)
PROPERTY ADDRESS: _________________________________________________________________
Tax Map No. _________-_______-_______-_________
Zoning District: ____________________________
Subdivision ___________________________________________ Acreage: ____________________________
Lot dimensions: ________________________________________
APPLICANT CERTIFICATION AND DESIGNATION OF AGENT
I (we) certify that the information in this application and the attached Form 2, 3, 4 or 5 is true and correct. In the event
any information given is found to be false, any variance granted may be revoked at any time. I (we) hereby appoint the
person named as my (our) agent to represent me (us) in this application. We further certify we have received this
information package regarding the Board.
________________________
_____________________________________________
Date
Property Owner’s Signature
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