05-038 (6) t
�— Date F _-- ! File No.
Z0 PERMIT APPLICATION
rdinance Section 10.2
1. N eof A
Address: — !� "? Telephone:
1771_a &--
2 . Owner of Property: Sr <<1P
Address: Telephone:
3 . Status of Applicant: ✓Owner Contract Purchaser
Lessee other (explain: )
4 . Parcel Identification: Z ning Map Sheet# Parcel#-
Zoning Districts) f
Street Address
5 . Compliance with Zoning: Existing Proposed
Use of Structure/Property
Size of Structure (sq. ft. )
Building height
% Building Coverage
Setbacks - front
- side
- rear
Lot Size
Frontage
Floor Area Ratio
% Open Space
0
Parking Spaces
Loading Spaces
Signs
Fill (volume & location)
6 . Narrative Descri tion of Pro nosed Work Pro •ect: (Use
additiona sheets if necessary) . 7
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: `Z j ) Applicant ' s Signature:
THIS SECTION FOR OFFICIAL, USE UNLY
Approved as presented
Denied as presented
Reason for Denial:
Signature of Building Inspector �,.s'•�,� 1-? �7 �� 2 < i1 Date �>^� '