APPLICATION FOR APPEAL                                                          Case Number__________

BOARD OF ADJUSTMENT                                                                      Received On__________

LEE, NEW HAMPSHIRE                                                              Fee               __________

(603) 659-6783                                                                            Public Hearing ________

                                                                                                            Decision         _________

OWNER:  _________________________________                              Appeal:          _________

APPLICANT: ______________________________                        Rehearing:     _________

ADDRESS:  _______________________________                                  Decision:       _________

                     _______________________________

TELEPHONE:______________________________

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LOCATION OF PROPERTY: ____________________________________________________

DESCRIPTION OF PROPERTY: _________________________________________________

Frontage:  _________ Left Side: _________ Right Side: __________ Rear: ________________

EXISTING USE: _______________________________________________________________

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THE APPLICANT HEREBY REQUESTS:                                        ARTICLE            SECTION

(   ) Appeal from an Administrative Decision

       in relation to .................................................................                 ______             ______

(   ) A Special Exception as provided in .............................      ______             ______

(   ) A Variance, and asks that said terms be waived

       as stated in ...................................................................                  ______             ______

(   ) Equitable Waiver of Dimensional Requirements.........                          RSA 674:33a

TO PERMIT THE FOLLOWING:  _________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Signed: _________________________                      Signed:_____________________________

                        (owner)                                                                        (applicant)

            __________________________                                _____________________________

                        (owner)                                                                        (applicant)       

NOTE:  This application should be accompanied by a list of all abutting property owners, names and addresses and application fees in the amount of $90.00 for advertising and $8.00 for each abutter and applicant to be notified.  Where appropriate, plans should also be included.  Completed forms must be filed at least 20 calendar days prior to the Board’s scheduled meeting.  The applicant or his representative is requested to attend the public hearing held on the above request.  All applications must be signed by the property owner or, where applicable, by a notarized designation of agent.

            Application must be accompanied by an appropriate plan(s) drawn to scale showing dimensions, abutting properties and structures, locus and tax map reference.  Sufficient copies must be submitted for each Board member.                                                                                                                                              

Revised 3/03