24C-003 (3) 10. Methodofheating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
' The undersigned certifies that the above statements are true to the best of his, her
kn e and belief
$ nature of responsible app,lcant
Remarks c=-- t CS e—E'
PERMIT APPLICAT CHECK LIS
.PAGE � PLOT ZONE Gth d 3l � YES NO QXTE
ZON ING FORM C IO
2 . PERMIT I
3 . OWNER OCCUPANT # IF NOT A
4 . 3 SETS OF S PL
5 . NEW CONSTRUCTION
6 , CURB CUT
7 WATER S
8 . REMODELING
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 , SIGN / AWNING
2 PERMIT F E C I0 — MONEY O D
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 — C R 780
15 , FORM
16 FILL
COMMENTS-
00334
9
Date Filed File No.
ZONING PERMIT APPLICATION
1. Name of Applicant::aUL- �".`T'a.c. Y
Address:pp 3oX Lt�, y4s+��tct_D+!.� Telephone: ,r_, z8- 383
2 . Owner of Property: V_eUQ L-_-r +, -r e;Ar e.
Address:z3 i Telephone: d454
3 . Status of Applicant: Owner contract Purchaser
Lessee Other (explain
4 . Parcel Identification: Zoning Map Sheet# _20"-d Parcel# 3 ,
Zoning District(s) (inclugli overlays) fl
Street Address --9-3
Required
6, Existin Proposed -by Zoning
Use of Structure/PropertytP
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R, L: R•
- rear
Lot size
Frontage.
Floor Area Ratio
• oopen 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) t_p�,,�,c.
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.*
Date: 9 Ag/9. Applicant's Signatu
THIS SECTION FOR OFFICIAL USE ONLY: - - r - r
Approved as presented/based on information presented
Denied as presented--Reason:
S cial'' Pe and/or Site Plan Required:
g R q Variance Required:
S gnat of ui.ldin pector_ Dat r
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply Willi all zoning requirements and obtain all required permits
from tho Board of Hoalth,Conservation Commission,Dopattment of Public Works and other applicable permit granting authorilios.
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