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RECORD OF VARIANCE UNION COUNTY, SOUTH DAKOTA, Number Variance requested by: Address: Home Phone No. Legal Deseription® Reason for request Provisions ofthe Zoning Regulations ofthe Land Use Development (Ordinance for which a variance is sought. Signature of Petitioner (Property Owner) State of. ee County of. ) On this day of, before me, the ‘undersigned, a notary public, personally appeared ikrown fo me tobe the person(s) described in and who executed the foregoing document and acknowledged that they/he/she executed the same forthe purposed therein contained. In witness whereof I hereunto set my hand and official seal. Tile of Ofticer [My commission expizes Fees: $ Pai ‘Rot paid Public Hearing Date Final Action of Planaing Approval Denial Date Chairman — Planning Commission Said variance is given and granted for the purposes above shown and shall continue for the period of time thatthe building placed on the property described above shall be and remain in its present form. In the event of the removal, destruction or reconstruction of said building, this ‘variance shal terminate and be of no further force and effect,