25C-249 (3) 1 D. 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 MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colmm to be fi77ed in
by the Bmilding Department
Required
Existing Proposed By Zoning
- F
Lot size S so $S 80
Frontage 5 7S-
Setbacks - front ?
- side L: 15- R: 18; L: z R: xg;
- rear t so
Building height 20 ' 20
Bldg Square footage 10 `.T 10 `-1
%Open Space:
Lot area minus bldg Cl,
&paved parking)
# of Parking spaces Z Z
#. of Loading Docks
Fill:
. (volume & location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of ray know edge.
DATE: gI2-} `qs- APPLICANT's SIGNATURE Ckc�L�
NOTE: lssuanoe of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Pubiio Works and other applioable permit granting authorities.
FILE if
r
i
Fi l e No.9&1 6 AUG 99 I;,'�5
ZONING PERMIT APPLICATION (§10 . 2 DENpRJryp�p�ON MAOI06Q�S
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: V,'i0_T I. 4"
Address:-14i at-6 R e rt r v z7*A-"j P;7_j Telephone: 5 94 -3 3 Go
2. Owner of Property: V")0'r c_4&01_ G(-ANA
Address:44t nLo PtNA_4V f4 4" Telephone: 58,t-33LL)
3. Status of Applicant: ✓Owner Contract Purchaser Lessee
Other(explain):
4. Street Address: 1-I l e Lb F OQ A In 20 A-D, ry a R 1 N+79-rr� PTt nl
Parcel Id: Zoning Map# LS C Parcel# 2 qq 00 1 District(s): U2!a
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property REFS t n Gry-n AC--
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
(ZkVLO)r,C C' AP 051A-L6 SIrD)N6 f-VArJTt SIRE . ae-10 10, 'F0VfVb4-1ar 2. NEbJ C�4001S
R��A�E �xtsr�+rc, F2o+yT eanc►4 A"LAC4 r-xlsr1nrG SME- &AQC#4 R Ace 0F7_LA.e—
_(L,tr t t C 4 CrAb boo e-
7. Attached Plans: 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.
8. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO V11- DON'T KNOW 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 ✓ 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)
l
r FILE
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: 2 A4Y
PROPERTY LOCATION:
MAP 4251i PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
lRivilding Perniit Filled out
A4e a tee_
TB
YFOLLOWING ACTION HAS BEEN TARN ON THIS AP ICA N:
_ roved as presented/based on information presented
as presented:
Special Permit and/or Site Plan Required der:§
PLANNING BOARD ZONIXG BOARD
Received&Recorded at Re stry 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
ermit fro Conservation Commission Ilebu¢a-1 Fa
"le,K�Z
Si ature of g Inspecto ate
NOTE:tasuanoe of a 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 Publio Works and other applioable permit granting authorities. —