Application for Variance

Penn Estates Property Owners Association

304 Cricket Dr. East Stroudsburg, PA 18301 P: 570.421.4265 F: 570.421.1092
Application for Variance
Date*

MonthDayYear
Date
Lot / Section:*
Name of Property Owner(s)*
Mailing Address:*
Phone Number*
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Name of Applicant (if different from owner):
Mailing Address:
Phone Number
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Email
example@example.com

Note in detail the circumstances that make it necessary to request a variance:
Note the specific provisions or sections of the PEPOA rules and regulations and/or the Protective Covenants that are involved in this request:
Describe the nature of the variance you are applying for:
Please list any reasons why you feel this request should be granted:
Note any unique physical circumstances, if any, which are creating the hardship, claimed:
Other circumstances that make it necessary for you to request a variance:
Were you in any way responsible for creating the hardship claimed?
Will the variance, if granted, alter the character or impair the use of adjacent properties?
Does the variance requested represent the minimum relief and the least modification possible?
Include below or on a separate piece of paper additional information deemed relevant to this application.
Signature of Owner:*

Clear
Date*

MonthDayYear
Date

If you will not be present for your hearing but will have someone there representing you, please give us the following information.
Name of Representative:
Mailing Address:
Phone Number
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Email
example@example.com
The above named person is authorized to represent me, my property and my interests before the Penn Estates Architectural Review Board.
Signature of Owner:

Clear
Date

MonthDayYear
Date
File Upload:

Cancelof
FOR OFFICE USE ONLY

Received by: _____________________________________ Date: ________________________

___Completed Variance Application
___Homeowner’s signature
___Notified ARB Chair
___Created packet for Meeting
___Letter of Notification of Meeting sent to applicant
Should be Empty:

Penn Estates Property Owners Association