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Receipt Date: Receipt Amount: Hearing Date: Office Use Only CITY OF LEWISTON PETITION FOR APPEAL Lewiston Board of Appeals c/o Code Enforcement Division City Building, 27 Pine Street Lewiston, Maine 04240 INSTRUCTIONS: Please print or type your responses to the following requests for information and add any attachments or exhibits that may support your appeal. Submit an original and eleven (11) copies of your completed petition for appeal along with any attachments, and the application fee of one hundred dollars ($150.00). Also, please include eleven (11) copies of a site plan (a site plan must be drawn to scale, show all existing and proposed structures, which includes fences, pools, decks, etc., and paved areas such as driveways, parking areas, etc.) along with eleven (11) copies of a deed; if you are not the owner of record you must also provide documentation showing your interest in the property subject to this appeal. Your petition and site plan will be forwarded to the Board of Appeals. The various chapters and sections that are mentioned in this petition are referenced from the Code of Ordinances of the City of Lewiston which is available for review at the Code Enforcement Office. A) Street address of the property in question: B) Legal name, address, and telephone number of petitioner(s): Tel: Tel: C) I/we hereby petition the Board of Appeals for a hearing regarding the following categories as checked: 1. Administrative appeal [Appendix A, Article VIII, Sec. 4(1)] 2. Variance [Appendix A, Article VIII, Sec. 4(2)] 3. Conditional use permit [Appendix A, Article VIII, Sec. 4(6)] 4. Modification of fence and wall standards [Appendix A, Article VIII, Sec. 4(8)] 5. Modification of yard, setback, height, lot coverage ratio, and open space requirements [Appendix A, Article VIII, Sec. 4(10)] 6. Other (Please specify and indicate the appropriate reference from the Revised Code of Ordinances of the City of Lewiston.) ---PAGE BREAK--- D) What is it that you are specifically appealing? Please be sure to be very concise in your response and, if applicable, include copies of denied applications for permits, a description of the change and/or new use, etc. Use additional sheets if necessary. E) Information regarding the property that is the subject of this appeal. 1. Legal name, address, and telephone number of owner of the property in question: Tel: Tel: 2. Zoning District Designation: 3. Shoreland Zone . . . . . . . . . . . . . . . . . yes no 4. Lake Conservation District . . . . . . . yes no 5. Ground Water Conservation District yes no 6. Flood Plain Management District . yes no 7. Is the subject property a significant structure or is it located in a significant district as per the preservation and conservation standards of Appendix A, Article XV, Sec. 3. yes no 8. Lot size: Lot Coverage Ratio: Existing: / Proposed: Impervious Surface Ratio: Existing: / Proposed: 9. Property Restrictions: a. Easements . . . . . . . . . . . . yes no b. Covenants . . . . . . . . . . . . yes no c. Prior Conditional Use approval yes /date: no d. Prior Variance approval . . . . . . . yes /date: no e. Briefly describe restrictions: ---PAGE BREAK--- 10. Describe current use of property to include size of structures, description of buildings, availability of parking, etc. If the property is in mixed use please give the floor area of each use. For non-residential uses, identify hours of operation, number of employees, etc. Use additional sheets if necessary. F) Statement of the reasons that you believe support the granting of your appeal (be sure to respond to the appropriate standards for the granting of appeals and respond accordingly) and in the event that the appeal is granted, describe the anticipated changes to the subject property. If applicable, be sure to include items such as new parking demand, hours of operation, etc. If any structures or additions to structures are to be erected or driveways, parking areas or other impervious surfaces are to be added or expanded be sure to include the proposed lot coverage ratio and the impervious surface ratio. Use additional sheets if necessary. petitioner's signature date petitioner's signature date owner's signature date owner's signature date