25-015 (40) l � FILE 962517
�Pj,,j�p NT/CONTACT PERSON:2�1
PROPERTY LOCATION: t /�-c2 —
MAP c PARCEL: ,� ZONE_
THIS SECTION FOR OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee
Biiilding Pe it F,114011t
Fee Pnid
-Rerrindelin2 Interior
Arlditinn to Existing
AC('PCC(lYV �trnrtu re
Ruildi V
3 Sets of Plqn-, /Plat Plan
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: § /0, 1
C�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
V`
Other Permits Required:
V
1� Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
t lPermitfrom Coat' Co ' on
6
Signature of Building for Date
NOTE:Issuanoe of a zoning permit does not relieve an appltoant'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 applicable permit granting authorttles.