MINOR LAND DIVISION / LOT SPLIT

ST ALBANS TOWNSHIP APPLICATION FOR ADMINISTRATIVE APPROVAL

DATE SUBMITTED APPLICATION NUMBER

TO BE FILLED
OUT BY
APPLICANT

Applicant(s): Phone Number:

E-mail Address:

Mailing Address: City State Zip Code

Authorized Representative \ Property Owner Signature(s):

Parcel Information:

Current Property Owner(s):

Current property owners, continued

Parcel Address: City Zip Code

Parcel ID #:

Original Acreage: Building Setbacks
(if applicable)

Proposed Lot Split(s):

TOWNSHIP
USE ONLY

Variance Application:YesNo Variance Section Number(s):

Was the Variance Approved:YesNo Variance Application Numbers(s):

Date Approved (Attach approval letter):

Zoning Classification: Building Setbacks (Minimum Requirements)

Minimum Frontage: Side:Rear:

Minimum Acreage:

APPROVEDDENIEDCONDITIONAL Zoning Inspector Signature Date

Zoning Inspector Printed Name

Comments: