ZBA Final Decision Form

For an appeal by right of this decision to be timely, it must be made to the court of proper jurisdiction within 30 days of the date of this order.

1) Appeal Number: _________________

2) Hearing Date: ___________________

3) Applicant: _____________________________________________

4) Address: ______________________________________________
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5) Phone: _________________________

6) Purpose of request: (variance, interpretation of zoning map, administrative appeal, other—please specify): ________________________________________________________
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7) ZBA Findings of Fact:
________________________________________________________
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________________________________________________________
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8) ZBA Decision: ________________________________________________________
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9) Reasons for Decision:
________________________________________________________
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________________________________________________________
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10) Vote of ZBA Members:

(Yes) (No) ______________________
(Yes) (No) ______________________
(Yes) (No) ______________________
(Yes) (No) ______________________
(Yes) (No) ______________________

11) Signature(s) of the ZBA chair or all of the ZBA Members:

___________________________________________

___________________________________________

___________________________________________

___________________________________________

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Certificate

I, __________________, Secretary of the _____________ Township Zoning Board of Appeals, certify that on this date I witnessed the signatures set forth above and attest to the accuracy of this report.

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