05-008 Date Filed 7 File No.
ZONING PERMIT APPLICATION (510.2)
1 . Name of Applicant:
Address: a7 CucsT Telephone: Sfi6- c
2 . Owner of Property: ry .
Address : -54 Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map SheetIS Parcel# ,
Zoning District(s) (includ ov lays)
Street Address
Required
5 • Existing Proposed by Zco in
Use of Structure/Property G.a
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size 9 '50 Pr --go, 000 t
Frontage.
Floor Area Ratio
%Open Space (Lot area minus
building and parking) �D
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) IS 7!1 �r 6veL�c:K6P �-dT
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge
Date:- �_3 a 2 Applicant's Signature:
THIS SECTION FOR OFFICIAL USE ONLY!
Approved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
Finding Required: Variance Required:
Signature of Building Inspector Date
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health,Consorvatfon commission, Dopaitment of Public Works and other applicable permit granting authorities.
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