PETITION TO THE BOARD OF APPEALS
City of Bridgeport, Connecticut
The undersigned presents the following petition for:
Variance Appeal from Zoning Officer Extension of Time Permit / Modification of Plan of
Development Request for Re-hearing Change of Condition(s) of Approval; pursuant to the Zoning
Regulations of the City of Bridgeport and/or the General Statutes of the State of Connecticut as to the
premises located at:
(Check all that Apply)
Zone
(Number) (Street) (Zone Classification)
On the side of the street about feet from
(North, South, East, West) (North, South, East, West)
Block : Lot:
(Street)
Dimension of Lot in Question
(Specify)
1. NAME OF PETITIONER / BUSINESS
(Print)
2. PETITIONERS INTEREST IN PROPERTY (OWNER, LESSEE, ETC.)
3. HAS ANY PREVIOUS PETITION BEEN FILED? IF SO, GIVE DATE OF HEARING
(Yes or No)
4. DESCRIBE PROPOSED DEVELOPMENT
5. THIS PETITION RELATES TO: Check all that Apply
Setback Coverage Landscaping Lot Area and Width Floor Area Height Parking
Extension or Enlargement of Non-Conforming Use and/or Building Coastal Area Management
Approval Liquor Use Other:
6. USE TO BE MADE OF PROPERTY
7. WHAT IS THE SPECIFIC HARDSHIP FOR GRANTING A VARIANCE (14-7-4)?
PETITIONER / DATE
(Signature) (Print)
If signed by agent, state capacity (lawyer, builder, etc /
(Email)
Mailing Address
(Zip Code) (Phone #)
PROPERTY OWNERS ENDORSEMENT Print
(If other than owner) (Signature)
Subscribe & Sworn to before me this day of 20
Notary Public in & for the County of Fairfield, State of Connecticut.
Note: READ CAREFULLY BEFORE FILLING OUT THIS PETITION
All questions must be answered in detail (use separate sheet if necessary).
The Petitioner or Agent for, must adhere to the attached check list or it will not be possible for
The Zoning Board of Appeals to process this petition.
NO PETITION RECEIVED BY MAIL CAN BE ACCEPTED.
PLEASE MAKE CHECK PAYABLE TO ZONING BOARD OF APPEALS
(REFER TO ZONING DEPARTMENT AS TO FEES 203-576-7217)
FEE RECEIVED: DATE: , 20 Clerk
FOR OFFICE USE ONLY (Rev. 6/22/16)
