BOARD OF APPEALS
PROJECT REFERRAL FORM
The purpose of the preliminary project review is to determine the Board of Appeals
action necessary for completion of the project you propose. You must have this form
completed by the appropriate Planning and Zoning staff member before filing your
application for review by the Board of Appeals.
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Property Owner
Property Address /03f )19.4v
Property Location: Tax Map 15
Project Description
Zoning
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Lot 2
Section
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Permit No.(s)
The project described above requires the following Board of Appeals actions, in
accordance with the Zoning Ordinance sections noted:
Specific Board of Appeals Action Required
Zoning Ordinance Section
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KUM OF APPEALS
EXHIBIT NO.
SUBMITTED BY
II,
EP 1 2 2014
RECEIVED
This project was reviewed by the undersigned staff member:
Date
Project Referral Approved by:
IL/6410
Policy DivisiPhief/Development Review Division Chief
Da te
(P&Z USE ONLY)
FEES: PER FEE S
CALVERT COUNTY
BOARD OF APPEALS
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Date Filed:
Fees Paid:
APPLICATION FOR APPEAL
,2
Receipt No..
Recd By:
Case No,:
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PROPERTY DESCRIPTION:
Tax Map No.
Tax ID No,
Parcel Block Section Lot
15
Property Address
Property Zoning
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Has the property ever been the subject of a previous Board of Appeals action?
(yes) (no)
If yes, please provide Case No. and approximate hearing date:
The Board of Appeals staff generally visits each property for the purpose of
obtaining information and photographs for a staff report. Does the Board of Appeals
staff have your permission for unscheduled visitation of your property during normal
work hours (8:30-4:30, M-F)?
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Do you have a dog that is kept outdoors on the property during the day?
PROPERTY OWNER(S):
Gokes
MAILING ADDRESS: )t) .--Poryic-;()Da
PRINTED NAME(s):
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TELEPHONE:Li-lb-to 10- S
EMAIL ADDRESS
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ALTERNATE NUMBER;
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CALVERT COUNTS'
BOARD OF APPEALS
APPLICANT (if different from owner):
SEP 1 2 2014
PRINTED NAME: RECEIVED
MAILING ADDRESS:
TELEPHONE: EMAIL ADDRESS
ALTERNATE NUMBER:
PURPOSE OF APPEAL
THIS APPLICATION IS FILED FOR: (check all items that apply)
Variance ( ) Multiple Variances
( )Revision to Previously Approved Variance(s)
Special Exception
Extension of the Time Limit on a Special Exception
Revision/Modification of a Special Exception
Expansion or Revision of a Non-Conforming Use
Reconsideration of a Previous Decision by Board
Re-Scheduling a Case Previously Postponed
Decision on an Alleged Error
Please Briefly Describe Your Request
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Directions to the subject property from Route 2-4: (Note: Failure to provide
complete and accurate directions may result in a delay to your case)
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CERTIFICATION
I hereby certify that, to the best of my knowledge and ability, the information I have
provided in this application is complete and correct, and I request that my application
be scheduled for the first available Board of Appeals public administrative hearing.
Owner's Sig ature and Date
Co-Owner's Signature and Date
App
Co-Applicant's Signature and Date
nt's S gnature and D
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PONDS WOODS
A Land Surveying Company
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tHJLEY
LOT 3
MINOR SUBDIVISION
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14604 Elm Street, Upper Marlboro, MD 20772
Fax: 301.888-1114
Phone: 301-888-1111
Fax: 1-688-55-DULEY
Phone: 1-658-86-DULEY
LIBER: 535 POLIO: 105
CALVERT GOLINTY, MARYLAND
SCALE- IWO OATE: 5-6-14
DRAIN?' BY: CPFILEA• 142757-200
For survey oidedapproval fOrrna, prices & more visit us at www.duley.biz
SURVEYORS CERTIFICATE
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