25C-133 (11) 10. Do any signs exist on the property? YES NO
IF YES, describe size,type and location:
r
fi
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 MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Tn-f er r b r` R c M o Q e 11� This co 7— to be ei2Zcd is
by the Bailding Department
Required
Existing Proposed By Zoning
w
Lot size � � sy,�fi ;25a S�. �`}. 10000 -t-
11 u„r�
Frontage
Setbacks -frnnt 2, Z_ f 2 '
- side L: 26 R:1�' L: 2-6 R:--97 L S
rear 3 <1 �t. r 120
Building height
3-1 `3 5-
Bldg Square footage 22'O �� ���� .3 p c�po
%Open Space:
'(Lotarea minus bldg �J
&paved parking) 9 t5oo ff. 5 60
S �� O
# of Parking spaces
of Loading Docks 0 Q
F_i11:
volume & location) n c{ Vt C a
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE .. �-
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden 1t6 oomply with all
zoning requirements and obtain all required permits from the Board of Health, conservation x
Commission. Department of Publio Works and other applionble permit granting authorities.
FILE #
� AUG 2 31��5
File No. lP���
DEPT RHAON INSPECTIONS MA 0
ZONING PERMIT APPLICATION (§1
PLEASE TYPE OR P=T ALL INFORMATION
1. Name of Applicant: l° f (� - Vl ,T Lie
Address: EC t Z4`o e.4 St- Telephoner 8 6 2.1--
2. Owner of Property: / I° f �l1 C L e
Address: EC ! Z.� �� Telephone: L">
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Street Address: l 4 - 4 � E [j 1 Z Q L e /y
S
Parcel Id: Zoning Map# "I .S-C. Parcel# A 3 3 District(s): LA
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property cQ-4- / IV
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan f)4(—Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking With the Building Dept or Planning Department Files.'
8. Has a Special PermiWariance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
J. Does the site contain a brook, body of water or wetlands? No DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM'CONTINUES ON OTHER SIDE)
1
FILE if 6 2
APPLICANT/CONTACT P RSON•
ADDRESS/PHONE: z
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZnNTNC�FORM FIT.T.F.11 OUT
Rivolfflng Permit MUM nut
IDI
D
t/
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
/Approved as presented/based on information presented
V Denied as presented:
ZSpecial Permit and/or Site Plan Required under:§ �7 O _
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
rmit from sery n Commission
S
ignature of g Inspector D e
NOTE:Issuance of a zoning permit does not relieve an app ioanVe 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 applioable permit granting authorities. —
ft)E
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