35-098 (10) r
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
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 column to be filled in
by the Rmilding Departmeat
(Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &Pal7ed Parking)
# of -Parking Spaces
f of Loading Docks
Fill:
(volume -& location)
13 . Certification: I hereby certify that the information contained herein
.a
is true and accurate to the best of my know dge.
DATE: J? - APPLICANT's SIGNATURE
}" NOTE: ins mnoe 6f as zoning permit does not relieve an ptioant's burden to oomp: wittr,.All
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other appliomble permit granting authorities:
=:``„ FILE #
MAP 2 5 File No. � t
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: L 1 r-, D P,
Address: (g--2];> \ �5 � � Telephone: '�%Li ' c�
2. Owner of Property:
( J a,
Address: 1 --5 ��9� �'h - Telephone: �`1 l 3 9 -a,
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT) ,!
5. Existing Use of Structure/Property . CC'�t 2z �X,�wo
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 PermitNadance/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_j� 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)
FILE # �j
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP <_��'� PARCEL: ZONE {'
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Riii1ding Permit Filled nnt
Tyne of Congtrurtion-
do J To,4!5.t'
Additinn to Existing e�� OL
ArressnuStructiiri, X.0 afl4
U ctS
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
Approved as presentedfbased 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 Conservat' Com 'ss'
Signature of Building eZtor Date
NOTE:Issuanoe of a zoning permit does not relieve an applloant's burden to oomply with all
zoning requirements eknd obtain ell required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authoritles.