34-024 (5) 10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin column to be filled in
by the BuilAi.ng Department
i Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &Paged Parking%
# of -Parking Spaces
#
of Loading Docks
Fill:
Avol-ume--& location)
13 . Certification: Thereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATU �� -
NOTE: lasua oe of a zoning permit does not relieve an applicant's burden to comply wltla�atl
zoning requirements and obtain ail required permits from the Board of Health. Conservotion
iCommisaion, Department of Public Works and other appiloable permit granting authoritiou.
FILE #
r1 l g e% Ei 1 e No. ,
•M�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: leo ®,,,11v�5 zw, / ` n711
Address: Telephone:
Owner of Property: fbLY�&e-ky�W6 _S, £X S'7&1V-E COhIEN
Address: 7T��� ��Q_/T �S 113, 12 ' t,; Telephone: 4(3-S�Vf-,20Xf7
c-(3-5Y -
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: TylefC N`tLL
Parcel Id: Zoning Map# 0,3Lf _ Parcel# ® '[ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property CM;4t OW Piet 116 — C 0S#60 fnAJ& SU6*6
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
L,A 42�K Tor' EN7ee tr' 7a Cdl+wvorA/ /eVAP U 10 7a I&"67E 14AI-Q
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 Permit/Vadance/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 V YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained V Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
` r FILE 1 �
jN
APPLICANT/CONTACT PERSSOI /' "-/-? - ,, �i
ADDRESS/PHONE ;LC
PROPERTY LOCATION:
MAP l PARCEL: ZONE /
TINS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
Enildiri- Permit Fillf, 3 nilt
Fee Pnirl
Tvr of CnnetrnrtiDn' --
Nmv C nyistriirtinn
Rernnrlelin2 Interior -- --- _--
Arlrlitinn EYic_ t to
I3>>i ld�ii�_I�3us_h�.r1.i it l_e_cL•— ------- -––------------I------ -------- ----------
_ -----
3 -----------
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP LICATION:
Approved as presentedfbased on information presented
!� ,
i�s nk J/� _� oV Denied as presented: i –
r
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § )N,/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
4' =rom roval-Bd of Health Well Water Potability-Bd Health
Conservat' Cornmiss.
�op
Signature of Buildin ector Date
NOTE:Issuanoa of a zoning permit does not relieve inn applioant's burden to oompty with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commisslon, Department of Public- Works and other applioabie permit granting authorltles.