APPLICATION FOR
HEARING BEFORE BOARD OF ADJUSTMENT

City of Clarkson Valley
15933 Clayton Rd., Suite 105
Ballwin, MO 63011
636-227-8607

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All information requested on this Application must be supplied. Application and all enclosures must be filed not less than fifteen (15) days before the Board of Adjustment Hearing. No Board of Adjustment Hearing will be scheduled until this completed application has been submitted. A minimum of fifteen (15) days after receipt will be necessary before a hearing date is set. No demonstrative evidence, photograph, diagrams, etc. will be considered by the Board of Adjustment that has not been presented to the City Clerk's office.  You are prohibited from contacting any Member of the Board of Adjustment to discuss your project prior to the Hearing.  The Members of the Board are required to view your property before the Hearing.  During the Hearing, you are granted twenty (20) minutes to speak on behalf of your project. This is a Legal Document. You may wish to consult an attorney regarding your request.


APPLICANT/OWNER________________________________________________________________________

ADDRESS _______________________________________________________________________________

HOME TELEPHONE _____________________ OFFICE TELEPHONE _________________________________

LOCATION:  Street Address _____________________________________________________________
           Subdivision ________________________________________________________________
           Lot No. __________________Lot Size _________________________________________
           If not in Subdivision, describe location:
           ____________________________________________________________________________
           ____________________________________________________________________________
           ____________________________________________________________________________

TYPE OF WORK: 	New Construction  	Addition   	Alteration   
			Replace  	Repair   	Demolition   	Other  
 
TYPE OF STRUCTURE (Describe):_________________________________________________________
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                             _________________________________________________________
                             _________________________________________________________
TO THE BOARD OF ADJUSTMENT:

Pursuant to the provisions of Chapter 18.120 of the Municipal Code of the City of Clarkson Valley, application is hereby made for a hearing before the Board of Adjustment of the City of Clarkson Valley, Missouri, for the following purpose(s):

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and the grounds for the request for the Variance sought are:
_____________________________________________________________________________________
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ATTACHED HERETO AS PART OF THIS APPLICATION ARE THE FOLLOWING:

   1.	Nine (9) copies of plats and plans showing:
	a.	topography
	b.	property and building lines (front, side & back marked)
	c.	easements
	d.	existing and proposed improvements
	e.	all proposed changes with exact measurements for zoning change sought
	f.	adjacent lots or tracts

   2.	The plats and plans must clearly cover and present the facts relating to this 
	application
	a.	must be certified within six (6) months of the date of this 
		application by a licensed engineer
	b.	elevation of the proposed new construction must be provided

   3.	Brief narration setting forth the specific grounds for the application.

   4.	Written consents (comments) from adjoining and neighboring property owners
	are required.

The undersigned hereby certifies and affirms that all the above statements and the
information contained in the above exhibits submitted herewith are true and correct.


__________________________________________         	______________________________
Applicant’s Signature (must be signed by Owner)			Date

Received by:  _______________________________		Date _________________________

Filing Fee $50.00 received   
Cost of Hearing $450.00 received   
Do you want a copy of the proceedings?  Check yes   

You will be notified by phone or mail of the Hearing date.