31A-198 (7) File No. �' Z(f.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ke) V\
Address: S V V ckS1-\I ky~i elephone: �S
2. Owner of Property + C-L-,O- � AA I
Address: 5 ,�/- Telephone: S 4
3. Status of Applicant: v Owner Contract Purchaser Lessee
Other(explain):: /�
4. Job Location: 5� w aSkt�"� hyV�
Parcel Id: Zoning Map# Parcel# 296,51, District(s):
(TO E FILLED IN BY THE BUILDING DEPARTME0
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
yVI
7. Attac0�Tns: Sketch Plan Site PI n° Engineered/Surveyed Plans
Answers to the following 2 questions may obtained checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Vadance/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? -n'
NO DON'T KNOW YES P I M
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO '�_ 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)
ems:«.. • ��
A w
Date Filed �3 13 e File No.
REGISTRATION OF HOME OFFICE/OCCUPATION (§10 . 2 & 11. 11)
With the Building Inspector
1. Name of Applicant: 1�
Address: !z f417 Telephone:
/ J
2 . Owner of Property: 141i7ki F f tea_ d /Ii/'c-
Address: 5 / Telephone: .Sc7►�a.
3 . Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other (explain: p
4 . Parcel Identification: Map f&M, , Parcel
Zoning District(s) (include overlays)
Street Address 5
5 . Narrative Description of Proposed Home Office: (Use additional s4eets
if necessary D VVIGC
t%i S e c�' " _ep I voh l
6. Is this a legal residential building? YES 2�5�
7 . Will there be an employee/owner who doesn't live in the home YES CNOJ
8 . Will you ever see clients or customers at your site? Q NO
How often 2 d_oe� �
For what purposes
9 . Will there be any signs) f-6r the Home Office? YES NO
10 . Will there be any goods sold from the premises or any sale of
goods stored on premises, either retail or wholesale, or any
display of goods on premises? YES
11. Will there be any outdoor storage of materials? YES NO
12 . Will your use be totally within a building and not cause any
outward manifestation (including traffic generation, parking
congestion, noise, air pollution, and materials storage) ? YES) NO
If NO explain:
13 . Attach Plans (if applicable)
14 . Certification: I hereby certify that the information contained herein
is true and accurate. I understand that if any information is incorrect,
my permit is null and void and I may be liable for non-criminal fines and
criminal and civil actions.
Date: �[�� l f Applicant's Signature:
THIS SECTION FOR OFFICIAL IISE_ONLY:
Approved as presented/based on information presented
APPROVAL EXPIRES ON DECEMBER 31 OF THIS YEAR AND MUST THEN BE RENEWED
Denied as presented-- eason:
Signature of Bi-1ding Inspector Date
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health,Conservation commission,Department of Public Works and other applicable permit granting authorities.
_ - � €
FILE # r 2 4
APPLICANT/CONTACT PERSON:�i � C
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP_ f PARCEL: _ ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
NCLOSED REQUIRED DATE
Building Permit Filled njit
Fee PAid
Additinn to Existing
Building Plan-, Tnrinded-
P 1/
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: `
Approved as presented/based on information presented
Denied as presented:
v pedal Pe-'r and/oTS1te-Plan Reid under: §�� (0, 1C�
PLANNING BOARD —YZONING BO RD
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 Conservatio ommissiolbe
j
Signature of Building or Date
NOTE:Issuance of at zoning permit does not relieve an applioant'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 authorities. _