2. 
4. 
6. Application is made to the Zoning Hearing Board of the Borough of Sewickley by the undersigned for:

   1. A Variance
   2. An Appeal
8. Applicant Signature
   Please enter your name.
9. Date
   Date
   Please enter today's date.
11. *Original signature mandatory. Please print, sign, and submit to the Building Inspector.*
13. *Applicant is responsible for all costs included, but not limited to: Stenographer, ZHB Solicitor, Zoning Officer Admin. Time, Legal Advertising, Certified Mailings. All costs must be paid prior to official decision being released. Failure to pay costs can result in citations being filed with the District Magistrate.
15. Name of Applicant
17. Address
19. City
20. State
21. Zip Code
23. Phone Number
24. Email Address
26. Name of the owner of the involved property
28. Address
30. City
31. State
32. Zip Code
34. Phone Number
35. Email Address
37. (a) What is the applicant’s interest in the involved property (owner, agent, lessee, etc.)? If the applicant is not the landowner, refer to (b).
39. (b) If the application is a request for a variance and is being filed by a tenant or other agent, has the landowner provided written permission, either by a notarized letter or by power of attorney, for the tenant to file this request?

    1. Yes
    2. No

    (Such permission is required by the Pennsylvania Municipalities Planning Code, Section 914, and is part of the documentation necessary to complete this application.)
41. A description of the involved property:
43. Zoning District
44. Lot Size
45. Lot/Block #
47. Location
49. Present improvement upon the land:
51. Present use:
53. Proposed improvement upon the land:
55. Proposed use:
57. Has any previous application for variance or appeal been filed in connection with this property?

    1. Yes
    2. No
59. IF APPLICATION FOR VARIANCE:
61. 
63. Brief description:
65. A copy of the plan of real estate affected showing location and size of lot, size of improvements now erected, size and location of improvements proposed to be erected, or other change desired, together with any other information required by the Zoning Hearing Board must be attached to each copy of this application. This information must make specific reference to the question being reviewed. Five copies if all drawings, sketches, or other documents larger than 11” by 17” must be included with this application.
67. What is the approximate cost of the work involved?
69. A brief statement of the relief sought and the variance desired:
71. A statement of the reasons both in law and in fact for the granting of the variance:
73. IF APPLICATION FOR APPEAL:
75. A statement of the grounds for the appeal: the specifications of error shall state separately the applicant’s objections of the action of the administrative officer with respect to each question of law and fact which is requested to be reviewed.
77. Where an appeal is filed, there shall be attached hereto a true and exact copy of the order, requirement, decision, or determination of the administrative officer.
79. FOR ALL APPLICATIONS:
81. 
83. Additional remarks:
85. I hereby certify that all of the above statements and the statements contained in any papers or plans submitted herewith are true and complete to the best of my knowledge and belief. A complete application document is required.
87. Applicant Signature
    Please enter your name.
88. Date
    Date
    Please enter today's date.
90. *Original signature mandatory. Please print, sign, and submit to the Building Inspector.*
92. **APPLICATION MUST BE ACCOMPANIED BY A CHECK FOR $550.00 PAYABLE TO THE BOROUGH OF SEWICKLEY.
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93. Print Only

* indicates a required field