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10. Do any signs exist on the property? YES NO V
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: 3. r %% I�" x I/8 "('zvoeden Jc� SIB
�O z ':5 1--+ LL on �rrid�e �d�^c�c-:T °ice- 6 dau a A& -Sholi) C)nZ
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col— to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of -Parking spaces
#' of Loading Docks
Fill:
(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: \5 APPLICANT's SIGNATURE '
NOTE: Issuanoe of a zoning permit does not relieve an applioanrs Luraen to pty w0t4,.Pll
zoning requirements and obtain all required permits from the Board of Health, Conservatio;
iCommisslon, Department of Publio Works and other applioable permit granting authorities.
:. ,. FILE #
File No.
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /"/U -54art c, r�;� l �u �p c'4T �c� 61�j a' j
Address: �.�, y1�+�( /7,�y Wyonsoekef A , L Telephone: 6�--W 6 7Y - 6�} -
2. Owner of Property:
C t
Address: � c ' i . O1 I Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
_ Other (explain): �Zn �au i15� c.� cic'S,T)a4'A SJ'f joc m( 0./V
4. Job Location: n�pr s.s awea -.1+ Afo4 ,loe t cand y- //t-/i ✓t'Vyaq
r G
Parcel Id: Zoning Map# 1� .J Parcel# District(s): ._.J
(TO BE FILLED IN BY THE UILDING DEPARTMENT)
S. Existing Use of Structur rop �.��°✓,�
6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary):
I� 240 aU s� 1 l oro� �'''W T /� _N�' — A c)ne -daq r�yeyi i
64c.d V --`I? l/N2�n ci�� f� 8- i7- 77 ) -404 Hm `1:30 m
7. Attached Plans: _ X _Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files,
3. Has a Special PermiWarianceiFinding ever been issued for/on the site?
NO DON'T KNO:^! V YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO---X1_ DON'T KNOW_ YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained X date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE #
pAPPLICANT/CONTACT PERSON: ' �,C � ! L6 , )
ADDRESS/PHONE:- )'9r,4j
PROPERTY LOCATION: —
MAP PARCEL: A O
THIS SECTION FOR-:OFFICIAL. USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ep Aid
Rnilding Permit Filled mit
Fee, pflid
Remndeli 2 Tnterinr
Acressncy Structure
Rod ing Plane Tnrlurlerl-
0-,vner/nrrunant ,'�tarpment nr T irence #
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION'
Approved as presentedibased 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: /E'n)� Ly ���,r� La jl��'r_�� x C': hj cou,,c. .
Curb Cut from DPW Water Availability Sewer Availability '
� c Approval-Bd of Health Well Water Potability-Bd Health
_Permit from Conservati ommissio — Qlfo,,,rcp 940
Signature of Building I ctor DA"
NOTE: Issuanoo of n zoning permit does not reliave ekn applionnt'n burden to oompty with nll
zoning requirements and obtain call required permits from the Board of Health, Conservation
Comminalon, Department of Publio Works and other npplionbla permit granting authorities.