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Thomas B. Quaw Square ▪ 91 E. Central ▪ Belgrade, MT 59714 Phone: (406) 388-3760 ▪ Fax: (406) 388-4996 Belgrade City-County Planning Office APPLICATION FOR A VARIANCE WITHIN THE CITY OF BELGRADE The undersigned hereby makes application for a variance pursuant to Chapter 17 of the Belgrade City Code 1. Name of Property Owner: 2. Name of Applicant: 3. Address of Applicant: 4. Phone # of Applicant: 5. Legal description of subject property: 7. Current Zoning: Land Area: 8. Variance request is for the following: (Use Additional Pages if Necessary) In addition to the above, submit a plot plan drawn to scale on paper not larger than 11”x17” which includes all existing and proposed structures and proposed variance measurements, a list of names, mailing addresses and labels of all property owners within 300 ft of the subject property, and a $1,120 filing fee. The application will not be considered until all required information is submitted. I hereby certify that the above information is true and correct for the above described property. Applicant’s Signature Date For Office Use Only Date filed: Filing Vote (4 yes votes are required to grant a variance) Board decision to approve/deny request/and or conditions of Chairperson