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2. Fields marked with an asterisk "*" are required and must be completed.
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Email*
16. Phone*
20. Type of Request*
    -- Select One --Special Exception RequestVariance RequestAdministrative ReviewOther
22. Description of Request*
24. Property Address*
26. Map Number
27. Parcel Number
28. Zoning Classification
    -- Select One --FARFRMRSRRB-1B-2B-3I-1I-2I-3C-1C-2C-3M-1BR
32. Online Form Complete By*
33. Date*
    Date
35. Fee of $200.00 required
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37. 1. Receive an email copy of this form.
38. Email address

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39. Submit

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