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Rev. 1-1-61
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Sheet No. 1 of 2 Sheets
Date ..tL t. /9 L ~
BOARD OF ZOIUNG APPEALS J
APPLICATlm: FOR VARIATION FROM THE REQUIRE1'1ENTS OF THE MASTER PLAN ZONING ORDINANCE
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11.... of Applicant a '4.U'tfK./ C}f/~ ~. Phone 110. f9h-t/3/
Name of Owner . J,-?,,--, -. Address ~ ;Lt!J Z / r
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,Street and / t!) t' - /.1/. . Street
Premises affected,. Street and No.
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Between
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Metes and Bouhds Description: (To be typewritten on s~parate, attached sheet.)
Lot-Plot Size _ Fronting on L~ ~ Street
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Date Deed was Recorded a~~.,---< ~/;.~u;tA~' .cj"1~.
Nature and Size of Improvements No'W Existing on Lo g~_ (~.L~--/ L-.
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I'Approximate Cost of Proposed Improvement t. /i!?# ~ U/-/;~'('7'
Attach on a separate sheet a full statement of variation applied fer under the
requirem~ntsof Master Plan Zoning Ordinance enacted October 27, 1959.
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STAT~-J)l:/IND~(..Nl\\~~ . COUNTY, 55:
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:- ~The und'EftS1ghed;, havj.ng boen dully swor!'l., upon oath says that the abOVE: ~
: ":"iri1orMati()n~'f.s- true and correct as he :i.s j.nformed and b€lieves. ..
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StJB&CRIBED AND SWOll1l TO BEFORE ,IE ~Ijf-~~:) 19 t y
jJotary Public
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MY COMMISSION EXPIRES: LlLlIM.J WICKER
M\! CtJl!ii;d.)~:u!l [/'I.};II.,,) .L:~e; 17. l~Cg
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A FEE OF /,"j'- ~ , TO BE PAID TO THE CARMEL TOWN BOARD OF ZONINlI APPEALS,
MUST ACCOMP.ANY THIS APPI.IC1'.TION. .
**See instructions on attached sheet.
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