Date Filed:
Case #:
Date Decided:
Property Address:
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
Name:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
City of Galva
311 N. W. 4th Avenue
Galva, IL 61434
Phone: (309) 932-2555
Fax: (309) 932-3306
www.galvail.gov
Appeal
Application
Page 1 of 2
Applicant's Information Owner's Information
(If different from applicant)
If "Other"
Explain:
For which
section of the
City's Zoning
Title are you
requesting an
appeal and why?
(Example: I am
requesting an
appeal of
Section 6.3-2 for
the following
reasons....)
Current Zone:
Relationship of Applicant to Property (select one):
I certify that as the applicant whose signature is affixed below, or as the applicants authorized agent,
that this application is true and correct to the best of my knowledge; that I have been advised of the fee
requirements established for an appeal and that the appropriate fee is herewith tendered; that I have
been advised as to the earliest possible date for a scheduled hearing and that as applicant or agent I
understand that I must be present at the scheduled hearing or the application will be continued until the
next scheduled hearing.
Page 2 of 2
Signature of Applicant:
Signature of Authorized
Agent (if any):
Fee Received:
Date:
Date:
Name & Title:
Instructions
Office Use Only
1. Complete the application form
2. Make sure the application is signed by the owner or the owner's agent (below)
3. Attach a metes and bounds description to the application here, or attach one to this application
4. Attach plats and other exhibits as necessary. If in doubt, contact the City Clerk's office for a determination
on whether or not such items will be necessary for a proper hearing. If necessary, the Clerk's office will
contact the Zoning Board of Appeals for a determination on additional documents that they may deem
necessary to render a proper decision. Be aware that most applicants will be required to submit a detailed
plot plan, drawn to scale, with all appropriate dimensions, showing the lot or lots included in the application,
the structures that exist thereon, and the structures contemplated, if any.
5. Ensure your application fee of $110.00 accompanies your application and other paperwork.
6. Be sure to present your paperwork to the City Clerk's office at least thirty (30) days prior to the next
meeting of the Zoning Board of Appeals.
Metes & Bounds
Description:
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