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Revised 7/9/18 Application to the Fair Haven Board of Appeals Name of person filing appeal: Date: Property Address: Phone: Mailing Address if different from above: Circle one: Owner Tenant Agent Contractor Other Specific location of lot in question (Refer to Zoning Map): The following items must be submitted before a hearing can be scheduled A disapproved building permit application with explanation must be attached or Included. All application fees must be paid in full. Detailed site plan to include: a) Drawings to scale with dimensions of existing structure or property. b) Drawings to scale of intended change or use reflecting distances to existing lot lines, roads and other existing structures on said property. c) Site location drawn on survey map showing requested variance. d) Survey to show all right-of-way’s A copy of a certified survey map is required. An Environmental Impact Statement (SEQR) may be required in some cases. A statement of why a variance should be granted and reason for appeal: (Office Use Only) Reviewed by Zoning Officer: Date Submitted to Board of Appeals: Decision: Copy to: Fair Haven Planning Board Fair Haven Board of Appeals Fair Haven Zoning Officer Clerk FEE: $250.00