Ashland City Fire, Building &
Life Safety Department
101 Court Street
Ashland City TN 37015
Fire & Life Safety: (615) 792-4531 – Building Codes (615) 792-6455
Application for Board of Zoning Appeals
Appellant: ______________________________ Address: _____________________________
Owner: ________________________________ Address: _____________________________
Location of Property: ____________________________________________________
NOTE: Fill in Section 1, 2 or 3 as appropriate. Do not fill in more than one of these sections. This application is not
acceptable unless all required statements have been made. Additional information should be supplied on separate sheets
if the space provided is inadequate. A Justification Statement and supporting documentation is required for Variance and
Special Exception applications.
Section 1: Appeal from decision of Building Inspector relating to the enforcement of the
zoning ordinance. Decision of the building inspector to be appealed: ________________________
________________________________________________________________________________
________________________________________________________________________________
Section 2: Application for a variance as provided by the zoning ordinance. The zoning
provision from which a variance is requested: ___________________________________________
________________________________________________________________________________
Peculiar or unusual conditions which justify the variance requested: __________________________
________________________________________________________________________________
**There is a $50.00 fee for a request for a variance. Submit a Justification Statement and any supporting
documentation to support the Variance.
Section 3: Application for a use on Appeal (Special Exception) The zoning provision which
allows a use on appeal to be considered: _______________________________________________
The type, description and size of the use to be considered: _________________________________
**There is a $50.00 fee for a Special Exception variance
Appellant Signature:_____________________________________
STATUS
Building Permit _______ Date _________
Date this application filed _____________
Notice of Hearing ___________________ Date of Hearing ________________________
Notice mailed to______________________
Application or appeal Granted / Denied in accordance with the terms of the following resolution:
________________________________________________________________________________
Building Inspector Signature: _____________________________________Date:_____________
