35-046 (7) Date Filed y % � File No.
ZONING PERMIT APPLICATION
I . Name of Applican
Address : lt.E kyw Ab Tel epho e: ,J
2 . Owner of Property: , 511JIfE
Address : , Telephone:
3 . Status of Applicant: ✓Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# Parcel# 02, .
Zoning District(s) (include o rlay 5�-
Street Address q 5
Required
5 . Existin Pro nosed by.-Zoning
Use of Structure/Property A057,0,�Z1✓C,5
(if project is only' interior work, skip to #6) <<
Building height g
%Bldg . Coverage (Footprint)
Setbacks - front
- side L: t R: . 6 L: R:
- rear
Lot size
Frontage. S"
Floor Area Ratio
. %-Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Pro ' ect : (Use additional sheets
if necessary) ON - CQIAI 4L
- QLfC l�-• o -
ws�u cr7f�til
7. Attached Plans: ✓ Sketch Plan 4te- Plan
8 . Certification: I hereby certify that the in ormat 'on ontained herein
is true and accurate to the best of my knowl ge.
Date: f � ( 3 j� Applicant' s Signature:
THIS SECTION FOR OFFICIAL USE O Y.
proved as presented/based on information presented
enied as presented--Reason:
Special' Permit /or Site Plan Required:
di Requir d. � �• Variance Required:
gnatur o uilding Inspe ate
NOTE: tssuance o(a zoning pe oes not tollave an applicant's burden to comply Wtgi all zoning requirements and obtain all required permits
from the board of Health, Conservation Commission, Dopadmont of Public Works and otlior applicable permit granting authoddos.