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2. Name*
4. Address*
6. City*
7. State*
8. Zip Code*
10. Phone Number*
11. Reply to Email Address*
13. Tax Parcel Number
15. Status*

    1. Property Owner

    1. Developer

    1. Other
17. Request of the Board*

    1. Policy Change

    1. Policy Exception

    1. Other
19. The Commissioners may review policy application and determinations under the following circumstances: to hear and decide appeals where it is alleged there is error in any order, requirement, decision or determination made by an administrative official in the enforcement or application of District policy; to hear and decide special exemption or general modification or revision to the terms of the policy; to authorize upon appeal in specific cases such variance from the terms of the policy as will not be contrary to public interest, where, owing to special conditions, a literal enforcement of the provisions of the policy will result in practical difficulty or unnecessary hardship, so that the spirit of the policy shall be observed.
21. Details
23. Reason you are requesting to appear before the Board*
25. Additional Pages
27. Requested Policy Change/Exemption
    Attach additional pages if needed
29. Additional Pages
31. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
33. Electronic Signature*
34. Date*
    Date
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

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