Petition for Variance Form

The undersigned petitioner, having been first duly sworn, on oath represents and petitions the Douglas County Board of Adjustment as follows:

1. That this action is an appeal from an order, requirement, decision or determination of the Planning Commission, Chief, Permits and Inspection Division, or authorized representative of Douglas County made on or about ______________ day of __________________, 20____, a copy of which is attached hereto as Exhibit "A" (denial of building permit).

2. That this petition is being filed pursuant to Chapter 25 of the Douglas County Zoning Regulations and Nebraska Statutes 23-168.01 through 23-168.04.

3. Said order, requirement, decision or determination of the Planning Commission, Chief, Permits and Inspection Division, or authorized representative of Douglas County is in order for the following reasons (state all references to statutory law, ordinances, regulations, orders, documents or instruments upon which the petitioner relies:

a. ________________________________________________________________

b. ________________________________________________________________

c.________________________________________________________________

4. The legal description of the real property to which said order, requirement, decision or determination applies is as follows (attach copy of deed as Exhibit "B"):

________________________________________________________________________

5. An 8 ½" x 11" map or plan of the area, drawn to scale, as described in paragraph 4 above is attached hereto as Exhibit "C".

6. That there are special circumstances or conditions described below, which are peculiar to the real property or building, and which have not resulted from any act of the applicant.

a. ________________________________________________________________

b. ________________________________________________________________

c. ________________________________________________________________

WHEREFORE, petitioner respectfully prays that the strict application of the Zoning Regulations of Douglas County be varied or adjusted as follows: _____________

________________________________________________________________________

Petitioner
______________________________

State of Nebraska )
) SS.
County of Douglas )

SUBSCRIBED AND SWORN before me by _____________________________

This ______________ day of ________________________, 19 _____.

Witness my hand and official seal.

__________________________________________
Notary Public

My Commission Expires:

_____________________

_____________________________________

Attorney for Petitioner
(Insert "none" if petitioner intends to proceed without legal representation).

1. ___________________________ ____________________________________
Name of Petitioner Street Address

____________________________________
City, State, Zip Code

2. Location at which variance is requested:

__________________________________________________________________
Address

______ _________ ________________
Lot Block Addition

3. Date the land was acquired ___________________________________________

4. Zoning District ____________________________________________________

5. The land and or buildings under construction are presently being used as:

________________________________________________________________________

6. Describe the nature of the variance requested.

________________________________________________________________________

7. State whether the proposed variance would reduce a required yard or area of an existing use, structure or parking space.

________________________________________________________________________

8. FINDINGS REQUIRED

a. State whether the strict application of the zoning regulations would produce undue hardship.

________________________________________________________________________

b. State whether such hardship is shared generally by other properties in the same zoning district and the same vicinity.

________________________________________________________________________

c. State whether the authorization of such variance would be of substantial detriment to adjacent property, whether the character of the district will be changed by the granting of the variance.

________________________________________________________________________

d. State whether the granting of such variance is based upon reasons of demonstrable and exceptional hardship as distinguished from variations for purposes of convenience, profit or caprice.

________________________________________________________________________

9. This petition for variance is submitted with the appropriate fee to Douglas County to cover costs of notices and processing. The Chief, Permits and Inspection Division, or authorized employee of Douglas County are hereby authorized to enter upon the property during normal working hours for the purpose of becoming familiar with the proposal.

___________________________ ________________
Signature Date
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(For Office Use)
Date Received ____________ rev. 1/99
Fee Received ____________
Received By ____________