12C-087 (5) 10. Do any signs exist on the property? YES NO l/
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: 'i
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This - - to be filled 1II
by the Bnildiag Depart==t:
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- 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: / � � APPLICANT's SIGNATURE
NOTE: Issuance at a zoning permit does not relieve an mp ionnt's b rden to oompty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Public Works and other applicable permit granting authorities-
FILE #
Fi 1 e No. SE141-,--
,
ZONING PERMIT APP.LIGATION (§1 cF au'4 b G!!JSPFCTiO
ORTHR�'�°TO�� 9'4 pI CT
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: i �'f� ��Di7 c��G /i1tcl-e4'S
Address:— , 9 'ti(f �r�t,�� �lc�?,('%IC Telephone:
t
2. Owner of Property: •:S'/a/)YL Ql
Address: Telephone:
3. Status of Applicant: ZOwner Contract Purchaser Lessee
Other(explain):
4. StreetAddress:__, �
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ) �C•1 >1 f; ��
6. Description of Proposed UseA/Vork/Project/Occupaton: (Use additional sheets if necessary):
r {'L'/
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 f=iles.
8. Has a Special Permit/Variance/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 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 L/ DON'T 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)_
i
FILE # '960228
APPLICANT/CONTACT PERSON: G � -
ADDRESS/PHONE: c�
PROPERTY LOCATION: t ' c
MAP PARCEL: Dz!J ZONE
THIS SECTION FOR�OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Ft-k-paild
J
It-'e,I-
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based 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:
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 comply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
� a p
Date File a File No.
REGISTRATION OF HOME OFFICE/OCCUPATION (§10.2 & 11.11)
With the Building Inspector
1. Name of Applicant:
Address j�iGIL %�/,�'�' �; F�r��%�v7�_�_ Telephone--
2. Owner of Property:
Address:_ RtLk Telephone: 5 - A 2 i
3. Status of Applicant: v Owner Contract Purchaser Lessee
Other (explain:
4. Parcel Identification: Map if --A-r--Parcel # V ,
Zoning District(s) (include overlays)
Street Address
5. Narrative Description of Proposed Homy Office: . (Use additional sheets
if necessary) Ail i eX6 nn ,c.%..
A _
6. Is this a legal residential building? YES_) NO
. 7. Will there be an employee/owner who doesn't live in the home YES X01
8. Will you ever see clients or customers. at your site? (YES) NO
How often rr 6 '--
V���
For what purpl3ses id,,CLS 14f 4", T--jJWI es aJe r-
9 . Will there be any signs for the' Home Off ice? :7 -YES! NO
10. Will there be any goods sold from the premises or any sale of
goods stored on premises, either retail or wholesale, or any
display of goods on premises? YES NO)
11. Will there be any outdoor storage of materials? ;�,j�, NO
12 . Will your use be totally within a building and not cause any�`
outward manifestation (including traffic generation, parking ----,
congestion, noise, air pollution, and materials storage) ? iYES) NO
If NO explain: —
13 . Attach Plans (if applicable)
14. Certification: I hereby certify that the information contained herein
is true and accurate. I understand that if any information is incorrect,
my permit is null and void and I may be liable for non-criminal fines and
criminal and civil actions.
+
Date: `?,b", � Applicant's Signature: ' �•�,
-
THIS SECTION FOR OFFICIAL IISE NLY:
Approved as presented/based on information presented
�: GEMBER 31 OF THIS EAR AND MUST THEN BE RENEWED
S ' atur Build in pector Date
NOTE:Issuance of a permit does not relieve an applicant's 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 applicable permit granting authorities.