03-008 (4) rr` n410
FILE # V
APPLICANT/CONTACT PERSON: i GO//C� -40--a,7L
ADDRESS/PHONE: ' _
PROPERTY LOCATION: / C� >
MAP PARCEL:
THIS SECTION FOR.-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Pnid r ( 3 � ✓ 07 s
Building
F Paid
Owner/Orrnnnnt qtatement or License h!
X11
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
Approved as presented/based on information presented
Denied as presented:
ySpecial Permit and/or Site Plan Requiredy�der: §4.
PLANNING BOARD t 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:lssuanoe 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 applicable permit granting authorltles.