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Application - Board of Zoning AppealsRevised 7/21/08 City of La Vergne, Tennessee 5093 Murfreesboro Road, La Vergne, TN 37086 ♦ (615) 793-6295 BOARD OF ZONING APPEALS APPLICATION APPLICANT INFORMATION (Please Print or Type - Any Correspondence will be addressed to the individual.) 1. Date of Application: ______________ 2. Phone Number:____________________ 3. Property Owner’s Name: __________________________________________________ 4. Property Owner’s Address: __________________________________________________ __________________________________________________ 5. Your Name (If Different): __________________________________________________ 6. Address: __________________________________________________ __________________________________________________ 7. Property Location: __________________________________________________ _________________________________________________________________________ (If additional space is needed, please use an additional sheet of paper.) Section 1 - Appeal the Decision of the Building Inspector / Codes Enforcement Officer. 8. Decision of the Building Inspector / Codes Enforcement Officer: ______________________ ____________________________________________________________________________ (If additional space is needed, please use an additional sheet of paper.) Section 2 - Application for a Variance / Special Exception. 9. Type of Variance / Special Exception Needed: ____________________________________ _________________________________________________________________________ 10. Peculiar or Unusual conditions which justify the Variance Requested: ________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ (If additional space is needed, please use an additional sheet of paper.) Revised 7/21/08 In granting a variance, the Board shall ascertain that the following criteria are met: 1. Variances shall be granted only where special circumstances or conditions, fully described in the finding of the Board, do not apply generally in the district. 2. Variances shall not be granted to allow a use otherwise excluded from the particular district in which requested. 3. For reasons fully set forth in the findings of the Board, the aforesaid circumstances or conditions are such that the strict application of the provisions of this ordinance would deprive the applicant of any reasonable use of his land. Mere loss in value shall not justify a variance. There must be a deprivation of beneficial use of land. 4. The granting of any variance shall be in harmony with the general purpose and intent of this ordinance and shall not be injurious to the neighborhood, detrimental to the public welfare, or in conflict with the comprehensive plan for development. 5. In reviewing an application for a variance, the burden of showing that the variance should be granted shall be upon the persons applying therefore. 6. Variances must return to the planning commission for site approval and be accompanied by a written explanation from the Board of Zoning Appeals stating the reason the variances was granted or was not granted. __________________________________________ Date: ____________________ Applicant Signature Revised 7/21/08 Certification Statement I hereby certify that _________________________________________ is the owner of the property located at _____________________________________________________ which is the subject of this application, and that I, ______________________________, in my capacity as ______________________________________, am authorized to sign this application on behalf of the owner. I understand that knowingly providing false information on this Application may result in any action taken heron being declared null and void. I further understand that pursuant to TCA 39-16-301 et seq., knowingly making a material false statement, or otherwise providing false information with the intent to mislead a public servant in the performance of his duty is punishable as a Class B misdemeanor. _________________________________________ ____________ Signature Date _________________________________________ Printed Name and Title Note: A Certification Statement must be submitted with an application form requiring the owner’s signature if the owner of the subject property is a corporation, limited liability company, partnership, association, trustee, etc., or if someone other than the owner signs the application. All Certification Statements must be notarized. _________________________________________ ____________ Notary Signature Date