p e n n s v i l l e t o w n s h i p p l a n n i n g b o a r d（p e n n s v i l l e t o w n s h i p p l n n i n g b o r d）（20页）.docVIP

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p e n n s v i l l e t o w n s h i p p l a n n i n g b o a r d（p e n n s v i l l e t o w n s h i p p l n n i n g b o r d）（20页）.doc

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ELMER BOROUGH LAND USE BOARDAPPLICATION COVER SHEET(to be completed for all applications and appeals) Applicant Name(s): Applicant Address: _________________________________________________________________ Applicant Telephone No.:_______________________________________________________________ Applicant Email: Owner Name(s) (if other than applicant):_________________________________________________ Owner Address: _______________________________________________________________________ Type of Application: _________________________________________________________________ Property Address/Location: ___________________________________________________________ Property Tax Map Block(s) and Lot(s): __________________________________________________ Zoning District: Present Use of Property: ______________________________________________________________ Proposed Use of Property: ____________________________________________________________ Amount of Fees Paid: ____________________________________________________________________ Amount of Escrow Deposited:__________________________________________________________ APPLICANT: The undersigned hereby confirms that (1) all information provided with this application is true, complete and correct; and (2) each applicant understands and will comply with the requirements of the Elmer Borough Land Development Ordinance, including but not limited to the applicants ongoing obligations to replenish review escrows upon request, and to reimburse the Borough for all professional review fees and costs relating to the application. Name: Signature: OWNER (if other than applicant): The undersigned hereby confirms that (1) the person(s) or entity(ies) named in line 5, above, are the only owner(s) of the property; (2) the applicant has entered into a written agreement with the owner(s) to purchase, lease, or otherwise use or occupy the property; (3) a true and complete copy of that agreement is attached to this application (with or without p