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0021 '71
Date Filed File No.
ZONING PERMIT APPLICATION (910 . 2)
I . Name of Applicant : D AU (--I �k Fa j ff
Address : 32 LAU,ct2l *. 4/darUA^.4Zj,✓ Telephone: 6'Ti4- gG�iS�
2 . Owner of Property: �1 1K R HAsl
Address : 31 UAu,ey C7-, Telephone: 6'g c!- 01 41 e)
3 . Status of Applicant: Owner Contract Purchaser
Lessee _Other (explain: ('u .v i/tA c Tut )
4 . Parcel Identification: Zoning Map Sheet# 3 ZC- Parcel# 21 �,
Zoning District (s) (include ovexlays
Street Address 3 ( V
Required
5. Existin Proposed by Zonincl
Use of Structure/PropertySIveu FA*,wt.Y ##14 aT*41.--t1u'tA-,•Ab#A i-F
(if project is only interior work, skip to #6)
ilding height 27
%Bldg . Coverage- (Footprint) _ .� - 10AI
etbacks front L 3
- side L: R: d !O L: 36'R: 10-10 1154
Lot - rear t ,
Frontage (p00C� � P �OD(, t Q 000 + i 4
' g 4 4 , S' lya�,�
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project : (Use additional sheets
if Y one essay
� � �A.D!� A-�u i9P,4 r ,v K / o us
d q 4 x K$ o f�-f �? _ t�v _�.�t�v �°�+2 704 /3 X-)
7 . Attached Plans : _Sketch Plan Site Plan
8 . Certification : I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date:— (4,) (;- _ Applicant' s Signature:
/" THIS SECTION FOR OFFICIAL USE ONLY:
!/Approved as presented/based on information presented Jo .C3
Denied as presented--Reason :
special* Permi and/or Site Plan Required :
nd ' ng Requ ' ed ,,y3 ,�$ variance Required :
�s 9s
j8 gnatu e Bflildin g ector 46�
NOTE: issuance of a zoning permit does not relieve an applicant's burden,to comply with all zoning requirements and obtain all required pormits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities,
i c"7'1-
FILE jo J J
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: )
MAP , PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING F01RM OUT
Fee pnid
Building Perrnit Filled niit
Fep �—"
0 0
TPOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: '
Approved as presented/based on information presented
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:§ 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 20ervation issio
6
Signature of Building hLvadtor Date
MOTE:lssumnoe of at zoning permit does not relieve an applioant'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.
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