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BOARD OF ADJUSTMENT
NOTICE OF APPEAL '
NUMBER
z
A. I/WE Q 7,2
y~ 7
of
7-22 -21 (o
hereby appeal to the St. Croix County Board of Adjustment from the
decision of the Zoning Administrator. Whereby the Zoning Administrator
did:
1. Deny an application to:
Use land only for use as family residence
erect structure or building accessory building
alter other business
add to - industry
occupy other
or:
2. Incorrectly interpret the (Ordinance) (Map) number
B. LOCATION 4r kffF It, Section_ , T_g fr_N, R.
Subdivision Name Lot
City Village Township
C. A variance of section of St. Croix County Zoning
Ordinance is requested ecausa: Undue hardship, unique situtation,
etc.)
f a(
D. List all adjoining landowners names and addresses:
HAUL& Address Town State Zip
Date Filed Signed Appellant(s) or Agent
FEE OF $150 REQUIRED AT TIME APPEAL IS FILED.