36-244 (8) Date Filed File No.
ZONING PERMIT APPLICATION (§10. 2)
1 . Name of Applicant:? e I(Vv CA
Address : k rj 2 c Q. ���=i ,�l Telephone:
2 . Owner of Property: Div=�� L 11��� ��i�C�✓Lc�G
Address : v tccds Od Telephone: .SVy - 9S'Dz
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3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet#
Zoning District(s) (inclu ove�rla
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only- interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontaclle-
Floor Area Ratio
'Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of ;Proposed ork/Project: (Use additional she t�;
if nece hazy,) �o e�� i v,) Icy > C I���t kG S C., - -o
a /of—is S c)•t Tkk
d
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.
r
Date: le. Applicant' s Signature: d
THIS SECTION FOR OFFICIAL USE ONLY: + —
�pproved as presented/based on information presented
enied as presented--Reason:
pecial' Permit and/or Site Plan Required: Z C 2
i ing iced: Variance Required:
gna r Buzld�ng I ctor a
q OTE: issuances of a zoning permit does not relieve an applicant's burden to comply witli all zoning roquiroments and obtain all required pormits
rom tho Board of Noulth, Conzorvation Commission,Dopattmont of Public Works and otlior applicablo permit Vranting authodtlos.