If represented, please give APPEAL NO.:

the following information NAME: Rep. Name ADDRESS:

Address PHONE Phone Zone Section

BOARD OF ADJUSTMENT - NOTICE OF APPEAL

ADMINISTRATIVE REVIEW

I, , the undersigned hereby appeal to the Versailles-Midway-Woodford County, Kentucky, Board of Adjustment for authorization of a (Building Permit) or (Certificate of Occupancy) for the property located at , in accordance with the 1994 Amended Versailles-Midway-Woodford County Zoning Ordinance adopted and in force as of August 1994 and as subsequently amended.

Administrative Review appeal from Section Of the Zoning Ordinance by the Zoning Administrative Officer. Explain how the officer’s action or decision has injuriously affected or aggrieved the appellant. (Such appeal shall be taken within thirty (30) days after the appellant or his agent received notice of the action of the Administrative Officer.)

Please attach a copy of building permit application and site (plot) plan.

(Date) (Appellant’s Signature)

(FOR OFFICIAL USE ONLY)

BOARD OF ADJUSTMENT - DECISION OF APPEAL

In accordance with Article IV, Section 401A, the Board adopted the following motion concerning the Zoning Administrative Officer’s interpretation of the Versailles-Midway-Woodford County Zoning Ordinance:

Hearing Date Signed:

Chairman, Board of Adjustment

Zoning Administrator Date Filed

Date of Notice to Parties in Interest

Date of Notice to Newspaper

Date of Public Hearing Fees Paid: