Read Microsoft Word - ZB_Appl_RadiusMapRequest.doc text version

Town of Babylon

Radius Map Request Form

PROPERTY INFORMATION Suffolk County Tax Map Number: 0100

District

__________

Section

__________

Block

_______________

Lot(s)

__________

Section

__________

Block

_______________

Lot(s)

Property Address: _____________________________________________________ APPLICANT'S INFORMATION Name: ___________________________________________ Date: ____________ Address: ____________________________________________________________ ____________________________________________________________________ Town: __________________________ State: _______ Zip Code: _____________ Phone: ____________________________ Fax: ___________________________

____________________________________________________________________

MAP INFORMATION Desired Radius 200 ft. 200/500 ft. Additional set of labels Cost $200.00 $250.00 $50.00 Quantity 14 maps, 1 set of labels 14 maps, 1 set of labels

Set of labels and report (for residential property only) Additional maps TOTAL COST Other _____________ ft. _____________ (to be determined)

FOR TOWN USE ONLY Requested by: Date received: Finished radius map returned to: Ext.: 3011 / 3012 Created by/Date: Date: Zoning Board of Appeals

\Forms\Engineering\ZBA_RadiusMapRequest (11/02 - rev)

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Microsoft Word - ZB_Appl_RadiusMapRequest.doc

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