32C-166 (14) 004-161
Date Filed File No.
ZONING PERMIT APPLICATION (910. 2)
I . Name of Applicant:
Address : a yIV 1pU ,e Ea�,7 4,jyW-Telephone: vl -
2 . Owner of Property: �-CD GU/4fC>D
Address : )�� �,�e,� ,,,� ; e�T Telephone:
3 . Status -of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map beet j Parcel#
Zoning District(s) (include ov rlays) i rlr-
Ri-rapt Address ,
Required
Exis-tincr Proposed —by Zoning
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6 . Narrative Description of Proposed Work/Project : (Use additional sheets
if necessary) } -
7 . Attached Plans: Sketch Plan �lF-s Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: Applicant's Signature:
THIS sECTZON FOR OFFICIAL USE ONLY:
ro. ed as presented/based on information presented
2DOi� e as presented--Reason:
S ecial,; r, IS Site Plan Required:
Variance Required:
4
Signature of But ding Inspector Da 'e
NOTE: tssuance of a zoning permit does not repave an applicant's burden to comply wNi all zoning roquiroments and obtain all required parmris
from tho Board of Health, Consorvation Commission, Dopartmord of Public Works and otltor applicablo pormit granting nuthoritlos.