Date:
Fee:
As the Petitioner(s), I/We ______________________________________________________________ request
that the Town of Burgaw Planning Board recommend to the Town of Burgaw Board of Commissioners to
change the Official Zoning Map of the Town of Burgaw as defined in the Unified Development Ordinance
(UDO) as follows:
Property Owner
Deed Recorded in:
Book
Page
#
Pender County Registry
Location of Property
GEO PIN Number
Street Address:
Located between
and
streets on the
side of the street
Property Size
Acreage (ft
2
)
Street Frontage (ft)
Depth (ft)
Present Zoning District
Requested Zoning District
I certify that the following are owner(s) of the property subject to the rezoning request as listed in the
Pender County Registry.
NAME
ADDRESS
1.
2.
3.
4.
5.
PETITION FOR REZONING
APPLICATION
I furthermore certify that the following persons are owners of properties adjoining this property. A copy
of an applicable map must be attached which labels each of the adjacent property owners with the
corresponding numbers listed below and/or GEO Pin Numbers.
NAME
ADDRESS
1.
2.
3.
4.
5.
6.
7.
8.
Attach extra sheets if necessary.
Owner’s Statements & Signatures
[Required if applicant is not property owner]: In filing this application for a variance I/we, as the property
owner(s), hereby certify that all of the information presented in this application is accurate to the best of my
knowledge and belief. I hereby authorize the applicant to submit an application affecting the use of my property.
Signature of Owner(s): Date:
[Required if owner wishes to establish an agent (attorney, real estate agent, etc.)]: I/we hereby designate
_________________________________________ to act on my behalf regarding this application, to receive and
respond to administrative comments, to resubmit plans on my behalf, and to speak for me in any public meeting
regarding this application.
Signature of Owner(s): Date:
Applicant Signature: ____________________________________________________
Address: ____________________________________________ Phone: _________________________
Date: _______________________________________________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome