32C-134 (2) Qy7t M°�YGSS- • + �+' '"t C �Ra. s9 kr,. � h''X,.,', `:rlr '� 'yl, £
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APPLICANT/CONTACT PERSON-
SS/PHONE:
PROPERTY LOCATION 4. ,w
MAP c20� C PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUI RED DATE'
t T
Type of!^nnstn►rtion-
_Remndelin2 Interior
Accessory Structure
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented based on information presented *Building ONLY — Sign permits applied _
for separately
,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: § %N,/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 Consery miss'
Signature ildmg Inspector e .
NOTE:aasuanoa of a zoning permit does, an appiioant's ¢urden.to oompty wtth,,ali
zoning;irequare,ments-nnd obtain sail requredprmits from the t3oardot,Heaith. ConservMion
CQrr}Ct�µission. L7epartmenf of t?ubtio Wortts$ether appiioabie perttjit^granting authorities
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