BOARD OF APPEALS

Town of Livermore

Zone:

Lot Size:

Tax Map: Lot: Date:

REQUEST FOR ADMINISTRATIVE APPEAL

APPLICANT NAME:

MAILING ADDRESS:

TOWN:

TELEPHONE: Home

Work

Cell #

Fax #

OWNER OF PROPERTY:

PROPERTY MAP #

LOT #

The undersigned requests the Board of Appeals consider an ADMINISTRATIVE APPEAL. Relief from the decision, or lack of decision, in regard to an application for a permit, by:

The Code Enforcement Officer

The Planning Board

The undersigned believes that:

(Check One)

(Check One)

An error was made in the denial of a permit

An error was made in the granting of a permit;

The denial of a permit was based on a misinterpretation of the ordinance;

There has been a failure to approve or deny the permit within a reasonable period of time;

Other (Please explain on a separate sheet of paper).

Please explain in detail the facts surrounding this appeal on a separate sheet(s) of paper. You should be as specific as possible, referring to sections of the applicable ordinances, so the Board of Appeals can give full consideration to your case.

To have a valid Administrative Appeal application, you must provide information confirming that you are an aggrieved party as defined by the Town of Eliot Zoning Ordinance, Section 507.5.2. This section states: "An aggrieved person or party is a person whose land is directly or indirectly affected by the grant or denial of a Permit, Variance or Administrative Appeal under this ordinance or a person whose land abuts land for which a Permit or Variance has been granted".

I certify that the information contained in this application and supplements are true and correct.

DATE:

SIGNED:

Date accepted by the Town Clerk or CEO:

Appellant