35-005 (8) FILL E G 1-
6 M7 i�
APPLICANT/CONTACT PERS N- '7 7 - k
DEFT Of ADDRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CI3ECKLIST
ENCLOSED REQUIRED DATF_
A
Ellilr]inoyPPrmit Filled not
Frr Pair]
Tl'
Nrw (—nnstillrtinn
Reiundelino Interior
Ar]r]itinn to Frietino
Arrrctnr-%r Strnrtnrr
L]uilr]in� Plant Tnrlrrr]rri•
C
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented/based on information presented
Denied as presented:
} X Special Permit and/or Site Plan Required under: Z JO (U, ( l
_PLAN T` G BOARD _—ZONING BOA
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § ry/ZONI G BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
/
Variance Required under: § NNIZOINING 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 Healt44 Well Water Potabilit}--Bd Health
it se ion
Signature of Building Inspector D ate
NOTE:Issunnoe of n zoning permit does not relieve an applloant's burden to comply with all
zoning requirements and obtain a Board of required permits from the Boar of Health, Conservat.
Commission, Department of Publio Works and other applionble permit granting authorltle_
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 INFORMATTON.
This aolna to be filled is
by the Banding Department
. Required
Existing Proposed By Zoning
Lot size L.0-14__y
t.c A 5 `t. Z 3RD t�
Frontage Lot-5 51.ocn,
Setbacks --front_
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space: —
(Lot area minus ,bldg
&paved parking)
`Parking Spaces _
,#`of Loading Docks
Fill:
Avol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
D1'E r -?"I(a q-1 APPLICANT's SIGNATURE �;
NOTE: tssunnoa of a zoning permit does not relieve an applioont's burden to oompty with all
coning requiramants and obtain all required permits from the Board of Health, Conservation
Commisston. Department of Publio Works and other applloable permit granting authorities.
Olt'it F.TT,F f
� . .'
D8 � 6u3O7 V |
.�L �u� ' _
| \ ,
File No �
�
qm (510 . 2)
-_ -_'--_. _ _ -___-__ ___ _ --~-._~�~^~�~~^"
PI-FASF- TYPE OR PRINT ALL ZMFOPMAZICN
1. Name of Applicant:
Address:-- Telephone: '
- Owner_ of Property
Address: phone
3. Status ofApplicant: _—)(--Owner /�unhodPumhuuerLesnee
Other(exp{nio}:_____________
4. Job Cnration:
Parcel Id: Zoning Map Parce| District(s):-
FILLED
5. Existing Use ofSbuckure/Propedy____
G. Description of Proposed U =k/ k/P
CY
\
`
7. Attached Plans: SkehdhP/un ________SkeP|on Engineered/Surveyed P|eno
Answers to the following 2 questions rroy he obtained by checking with the Building Dept or Planning Department Files.
8. Has o Special Pennih\/-�ihunoe��indingevcrhcen issued forionthesite?
N DON'T KNO YES |F YES,date issued:
IF YES: Was the permit recorded ot the Registry ofDeeds?
NO DON'T KNOW YE
IF YES: enter Boo Page and/or Document
9' Does the site contain abnook. bodyof water orweUmndn? N DON'T�N �E
' . _---___
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs tobe obtained Obtaine .date issued:
-
(FORM CON11NDE8QNOTHER SIDE)