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Request for Variance Form
CITY OF SALEM
REQUEST FOR VARIANCE


Name: ________________________________________________________________

Address:  _____________________________________________________________

Telephone:  ___________________________________________________________

Legal Description of Property:  _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Relationship of said structure or use to existing structure or uses on adjacent lots:______________________________________________________________________________________________________________________________________________________________________________________________________________

Specific sections of this ordinance:  ____________________________________________________________________________________________________________________________________________

Would there be a hardship if variance were not granted?  If so, describe in detail:
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
                                                                                Signature
____________________________________
                                                                                   Signature of Property Owner
                                                                                                               (if different than above)