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17C-230 (4) 10. Do any signs exist on the property? YES ., NO IF YES,describe size,type and location: /-Y-" 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. This CO2== to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of Parking spaces # of Loading Docks Fill: .14 vol-time--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _1 DATE: /j "; APPLICANT's SIGNATUREi"� NOTE: lasuanoe of a zoning permit does not relieve an ApplioanbW bur en to oompty with,.all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other appliomble permit granting authorit;gs. FILE # 1 7W File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: � �) ,{�0� S - Telephone: i 2. Owner of Property: l Address: 3L .uC1��h x-!%�� �� - Telephone: 3. Status of Applicant: / Owner Contract Purchaser Lessee Other(explain): ) 4. Job Location: 4 Parcel Id: Zoning Map# e ParcelO ell(41 District(s): O BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 7/`}^, y i 6. Description of Proposed Use //Work/Project/Occupabon: (Use additional sheets if necessary): _L 8 JoI1 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/Variance/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, 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 Obtained ,date issued: (FORM CONTINUES ON OTHER SIDE) i a FILE # q ) O 6 '10 "D j _ X317 APPLICANT/CON`1ACT DIZESSIPHO�E•`b �- PROPERTY LOCATION: 30 MAP / T C. PARCEL: ,:?3,D a 36 F ZONE—,5-r- 7 THIS SECTION FOR-OFFICIAL USE ONLY: PERMUT APPLICATION_CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM Mj XT)D1 A�FLn� IRTYNding Permit Filled nut Fee paifi T:Vnr of Construction- 'New Cnnstnirtinn –Rem.priclinaa Interior Addition to Existing _Acressnry Strurturr Riiilrii l Plane Inrllirlerl' u 3 Sets of Plnns /Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIW Approved as presentedfbased on information presented —/ Denied as presented: Special Permit and/or Site Plan Required under: PLANNING BOARD 7,0NING bO:kI:ID Received <"Z 1Kec,>rded :it Re"i.try of Deeds Pr(-Y)f}:ncl�,•c�i minding Reduircd under. § w/ZONING BOARD OF APPEALS Received & Recorded at Registry of Deeds Proof Enclosed _Variance Required under § _i't >/ w/ZONING BOARD OF',kPPEALS Received &Recorded at Registry of Deeds Proof Enclw,ed — Other Permits Required: r, 4 era, z� iiLl qtn ? �}!„x ai rte_ 3 Cater Availability Sewer Availability �X Septic Approval-Bd of Health Well Water Potability-Bd Health t ogsEfv C Signature of Building Inspector Date NOTE: Is,suanoa of a zoning permit does not relieve an applloant's burden to oompty with all zoning requirements and obtain all required permits from the Board of Health, Conservation commission, Department of Publio Works and other applioable permit granting authoritles.