28-045 (3) i
10. Do any signs ebst on the property? YES NO x
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 cold to be fi 7 7..i is
by the Bmildiw Department
Required
Existing Proposed By Zoning
Lot size
� `TS
Frontage .273
,
Setbacks -frnnt '
- side L: R: L:
- rear
Building height _
Bldg Square footage
%Open Space: -
*(Lot area minus bldg �//� IV/4
&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: Z APPLICANT's SIGNATURE
NOTE: uanoe of as zoning permit does not relieve an applioan burden with all
zoning requirements and obtain all required permits from the Board of He th, Conservation
Commission. Department of Publio Works and other applloable permit granting authorities.
FILE #
JAN
File No.
a
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ED 1Jy4)2> 44 yi9L LE"� �jZ.
Address:2• �E.[�T�-YL �7" /V �TDit.J Telephone: 5B4, —912?Z
2. Owner of Property: 42>4J,o,122> LA �i4LL�y J'�2 `� 1 N E�2b��f D d.�¢U�,
Address: .SA!l7� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain): I $E 17El.DED Fkom M07-HfIG ?a .56,4-)
4. Street Address: S13 9YAAJ Rv A t _
.28 =¢z., g3, f 94
Parcel Id: Zoning Map##:'2!ej' _ Parcel# /ZZ District(s): .5/0
(TO BE FILLED IN BY TH E BUILDING DEPARTMENT)
5. Existing Use of Structure/Property op'6F-w 44, z>
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan X _Site Plan Engineered/Surveyed Plans
'DW6 *96 -00 3
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO DONT 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 DON'T KNOW YES �c
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
p (FORM CONTINUES ON OTHER SIDE)
E-
��C i4svD 75 02z;15S E.Y/ST/-Y,y _
C04,1/65W--r h� U7'1417'145:-�.
� JSo
FILE'. # �
APPLICANT/CONTACT PERSON., �� 2� V C2&Q
ADDRESS/PHONE: a/ �2
PROPERTY LOCATION:
MAP PAV,'TION: ZONE k
FOR�OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Paid
1Ryjildin2 Permit Filled nut
Fee Paid
Tvnr of t onstrurtion-
New C'nn-,trnrtinn
Remndelin2 Tnterinr
Aridition to FYicti
Arre-,-,nry Strnrtnre
Wilding Plan-, TnrInded-
Owner/0rrn[)nnt StatPmPnt nr T
Set-, of Plane / Pint Plan
THE FOLLOWING ACTION HAS BEEN TARN ON THIS APPLICATIOM
1 Approved as presented/based on information presented
X Denied as presented:
J 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 I 1
Variance Required under: E; (o w/ZONING BOARD OF APPEALS �� J
ioo, V1
Received&Recorded at Registry of Deeds Proof Enclosed w8a f� xw
Other Permits Required:
Curb Cut from DPW _ Water Availability Sewer Availability
Septic Approval-Bd of Health _ Well Water Potability-Bd Health
Permit from Conservation Commission
Signature of Building Inspector Date
NOTE: issuanoe 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 Publio Works and other applioable permit granting authoritles.