Town of Clinton
VARIANCE APPLICATION
No._______ (date filed)_________Fee deposited _________________ Attorney ID # _____________
(DO NOT WRITE ABOVE THIS LINE)
INSTRUCTIONS
Application for appeals to the Land Use Board of The Town of Clinton must be made on this form
and filed with the Secretary of the Board along with Twenty (20) Copies of Plot Plan/ Site Plan.
Additional information may be required by the Board.
After filing the application you will be notified of the date the hearing will be held on your application
together with detailed instructions concerning the procedure you must follow to give notice of the
hearing to adjoining property owners.
In the event a variance is granted, you are hereby notified that said variance shall expire unless work
is commenced and diligently prosecuted within nine (9) months from the date of the granting of the
variance.
1. Name of Applicant: ______________________________________________________________
Address: ____________________________________________ Phone _____________________
2. Name & address of present owner (if other than No.1 above)
3. Interest of applicant if other than owner: ______________________________________________
4. Description of property: ___________________________________________________________
How Zoned: ______________________________________________________________________
Street Address: ____________________________________________________________________
Tax Map Block No. ________________________________ Lot No: __________________________
Size of Lot: ______________________________________ Size of Building ____________________
Number, Size & Use of accessory buildings: _____________________________________________
Height of Building: _________________________________ #of Stories: _______________________
Setback from front property line: ________________ feet Rear yard: _______________ feet.
From side lot lines: __________________________ feet, and ______________________ feet.
Prevailing setback of adjoining buildings with block: ________________________________________
5. Attach a plot plan showing the block and lot numbers, dimensions of lot, dimensions of present
and proposed structures, and location of all structures in relation to all other structures and to
property lines and plans of any proposed buildings.