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10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MIDST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This color to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size yG koo L- G yac Sq (-T ,3 cl'
Frontage g�- ' �2 06,y's-
Setbacks - 3c' ` 30
- side L: R: L:14 — R: So y
- rear -�
Building height S��Rt,, Veiy
Bldg Square footage ao
%Open Space:
(Lot area minus bldg 7/-/GD Sq r-r t
&paved parking)
# _pf -Parking spaces
of Loading Docks _O
Fail:
-{vol-dme--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DAZE:_ °(- APPLICANT's SIGNATURE
E:
NOTIss nnoe of a zoning permit does not relieve an appiioant's burden to oomply with all
zoning requirements and obtain nil required permits from the Board of Health, Conservation
iCommission, Department of Publio Works and other applicable permit granting authorities.
FILE #
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'PLEASE TYPE OR PRINT ALL INFORMATION
1. Name mVApplicant:
Addnasa .. .-Telephone: L
2. Owner mfProperty:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map Parcel# District(s):
(TO BE FILLED |NBY THE BUILDING DEPARTMENT)
5. Existing Use ofStruoture/P rope rty
G. Description nf Proposed Uce8Nork[,rojeot/Dooupation: (Use additional sheets ifnecesoarA:
7. Attached Plans: ___Sketch Plan _Sbo Plan ^~^--- Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
O. Has a Special Perrnit/Vahunoe/Finding ever been issued for/on the site?
N O — DON'T KNOW YES |F YES,date issued:
_________
IF YES: Was the permit recorded at the Registry nfDeeds?
NO DON'T KNOW YE
IF YES: enter Book Pugo and/or Document
Q. Does the site contain a brook, body of water orwetlands? NO DON'T KNOW YES u�--
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tob* obtuinod__________ Obtained .date issued:
_
(FORM CONTINUES ON OTHER SIDE)
4%
960759
FILE I
JPD IM M
&tMkPE
PERSON:
15
D nEPT FPT
OF
P
RM CA AA
MAY
PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED,REQUIRED DATE
ZONING FORM VU,T,FD ()ITT
Fee Pnid C e#d
Rivildin2 Permit Filled niit
Fee pniii
T3ZIie nf Cnngtnirtion-
New Cnmqtriyrtinn
_lRemndelin2 Tnterinr
Additinn tn Existing
Arreq,qni:V Striirfiire
IRT61ding PlAng Tnrhided-
int qtnternent nr Lirenspfi
3 Sek nf PinnQ /Plat Pinn
THE KLOWING ACTION HAS BEEN TAKEN ON THIS ANEICATION:
Approved as presentedfbased 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.§ WZONBNG 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 Conservation Commissi
Signature of STilding Inspect t/ DaTe
NOTE:tsaumnoa of as zoning permit does not relieve an appilaant's burden to oamply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
C,ommlaalan, Department of Publio- Works and other appiloabie permit granting authorities.