31B-260 (12) FILE # 9 C 1_ 8 8
APP SIC T/CONTACT PE ON• , ,r,(/14 ---(3
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ADD S HQNE / a./.6 _ _ etgeozi(%
PROPERTY LOCATION: /6 (;,,i2 % (-
MAP `3/f3 PARCEL: o7 ;C9-- ZONE ( ,3
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FTT.T N.T) OTTT G'' //t •/ %1 ✓
Fee Pain 2 - C -ct 0
Building Permit Filled nut
Fee Paid
Type of Canctr►►rtion•
New C'nnctrurtinn
Remndeling Tnterinr
Addition to FYicting
Arreccnry Structure9i-C1 / 6/0
�O
Building Planc Included
Owner/Orrupant Statement nr Licence #
3 Setc of Planc / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented
Denied as presented:
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 from Conservation Commission
Signature of Building Inspector Date
NOTE: issuanoe of a zoning permit does not relieve an applloant's burden to oomply 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 authorities.