34-004 (36) r
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: L Q-Llt r G1-
Address: Telephone:
2. Owner of Property: i x1 r` U c-JA
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other (explain): ru>iL1t e. aXt /h' 1�p2�6 .
4. Street Address: 'fLLi.KA-k ( w-t-If ( -5 y 4 MILD 27
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT) 6,2.i.c t,L T 2Ct
5. Existing Use of Structure/Property
6. Descrption of Proposed UseMvlork/Project Occupabon: (Use add uorial sheets if necessary):
l2 i (CA c- CIYA
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermitNadance/Finding ever been issued for/on the site?
No DON'T KNOW__ YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, ody of water or wetlands? NO DON'T KNOW YES _
C1'1ClL�11
IF YES, has a permit been or need to be obtained from the Conservation Commission? o
Needs to be obtained Obtained date issued:
(FORM CONTINUES ON OTHER SIDE)
On �L road , on r�� 1�i1- be-F�►�e qua-��
Nfci yU ri/t y Map ye--r
l l t [�
► FILE #
APPLICANT/CONTACT PERSON:ADDRESS/PHONE: C, ,
PROPERTY LOCATION:
MAP ''1 PARCEL: 11 , i L' ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FITIED OUT
Fee Pfdd 1 j t
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
,/Denied as presented based on information presented
Denied as presented: ��� C��� G: ���rz��. 'ct�� 1 � �_ C h t� /t/c' c,n e'-jc,; r)
lC �
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit m 7Cnservation Commission
gnature o�&King Inspector Da
NOTE:issuance of a zoning permit does not relieve an applicants burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Public Works and other applicable permit granting authorities. _