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CITY OF LACKAWANNA DEPARTMENT OF DEVELOPMENT 714 Ridge Road — Room 309 Lackawanna, NY 14218 Tel: (716) 827-6421 Fax: (716) 827-1866 APPLICATION TO THE CITY OF LACKAWANNA ZONING BOARD OF APPEALS Date: 2): / if LG : Application No. Application Fee: Fee x Land Use Variance $ 250.00 Zoning Law Appeal $ 250.00 Property Address: S | ite Je AQ Or [ (me S.B.L. No. Description of Action to be Appealed: Vac [An YW po } og a (LK 20 Shak OQ my Back yard. APPLICATION IS HEREBY MADE to the City of Lackawanna Zoning Board of Appeals for a Land Use Variance and/or Zoning Law Appeal as required by the Municipal Code of the City of Lackawanna. The applicant hereby agrees to comply with all applicable laws, rules, ordinances and regulations. Director of Development