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Town of Summerhill Board of Appeals Variance Applications Mailing Address Appeal Number Name of Applicant Road Address City State Zip Code (Area Code) Phone Number Tax Map Number Reason for Appeal: Please give a detailed description. Attach extra sheets is needed. Please attach a sketch and/or map of the property in question. (Include locations and outlines of all buildings, measurements, etc.) Please attach names and addresses of all property owners whose property touches on this one. Also, include any that are situated directly across a public or private road from this property. Page 1 of 2 Date Location of Property Road Address City State Zip Code (Area Code) Phone Number Print Form ---PAGE BREAK--- Town of Summerhill Board of Appeals (continued) Previous Appeal: Have any other appeals been previously made with respect of this property? If so, please indicate below, when and the result of the appeal. Date Granted Denied Date Granted Denied The following four factors will be considered by the Board of Appeals and should be addressed by the variance applicant: 1. Whether an undesirable change will be produced in the character of the neighborhood or a detriment to nearby properties will be created by the granting of the variance. 2. Whether the proposed variance would have an adverse impact on the physical or environmental conditions of the neighborhood. 3. Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue, other than the variance. 4. Whether the alleged difficulty was self-created. The last facto shall be relevant to the decision of the Board of Appeals, but shall not necessarily preclude the granting of the variance. I CERTIFY THAT THE INFORMATION SUBMITTED WITH THIS APPEAL IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. *Only owner(s) of the property to which this appeal applies, or agents designated in writing by such ownership(s), may sign this application. Signature of Applicant* Page 2 of 2