17A-197 (5) Ft
1
I �
Date Filed 00303
File No.
ZONING PERMIT APPLICATION (§10.2)
1. Name of Applicant: (Z. , StL-vIZK--,
Address!�•p .�p� °t 01 , (�( �-�• Telephone:
2 . Owner of P operty:
A t
inrtri Telephone: 2
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain:
4 . Parcel Identification: Zoning Map Sheet# %2-) Parcel#-,/z7 ,
Zoning District(s) (include overlays) /�Lh
Street Address
Required
5. ExistincT Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front S'
- side
- rear
Lot size ►d 000
Frontage
Floor Area Ratio `s
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project. (Use additional sheets
if necessary) r Z t L tKSJ-a:-
13 C-1
3T5 C
t o c, 2. I
7. Attached Plans: Sketch Plan Site Plan N •
8. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
,°T� Applicant's Signature:
- -
THIS SECTION FOR OFFICIAL USE ONLY:- - - - - - - -
ed as presented/based on information presented
as prese
---Read—on for Denia
Signature of Building Inspector Date
NOTE: lssuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health,Conservation Commission, Department of Public Works and other applicable permit granting authorities.