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Date Filed File No.
ZONING PERMIT APPLICATION
Zoning Ordinance Section 10.2
1. Name of A 1icant: Akz
Address: Telephone: 516 - YV?1 -
57* 06/0
2 . Owner of Property:
Address: f , 7/'L7% Telephone: , `S
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
0 4 . Parcel Identification: oning Map Sheet# 3YQ(�- Parcel#
Zoning District(s)
Street Address
5. Compliance with Zoning: Existing Propose
Use of Structure/Property
Size of Structure (sq.ft. ) T
Building height
% Building Coverage
Setbacks - front
side
rear
Lot Size -
Frontage
Floor Area Ratio
% Open Space
Parking Spaces
Loading Spaces
Signs
Fill (volume & location)
6 . Narrative Description of Pro osed Work/Pro ect: (Use .
additional sheets if necessary) L a
7 . Attached Plans: k Sketch Plan ✓ Site Plan
8 . Certification: I hereby certify that the inform tion contained
herein is true and accurate to the best of my know edge.
Date: ,/yJd Applicant' s Signature:
THIS SECTION FOR OFFICIAL USE ONLY
17
Approved as presented
Denied as presented
Reason for Denial:
Signature of Building Inspector zx� Date /417 �
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