06-005 (5) 0 C)05
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Date Filed File No.
ZONING PERMIT APPLICATION (Sib. 2)
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I . Name of Applicant: �S
Address: Telephone:.. _
2 . Owner of Property: �– �� / N J �G�� -- '6�
Address: , Telephone:
3 . Status of Applicant: Owner contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# Ev Parcel# 5 . ,
Zoning District(s) (include ov rl ys)
Street Address 5 1U U
Required
5 . Existincr Proposed - by Zonin
Use of Structure/Property Cr_-, <)ED /C—
(if project is only, interior work, skip to #6)
Building height
5.1,B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size '3
Frontage.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project: Use ddi�tional sheets
if necessary) e j(. ; -1)j cx o,S m /' ro44
7. Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the infarmatiqp contain erein
is true and accurate to the best of my know edge./.,,
Date: 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: lssuanoe o(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 Hoalth,Consorvallon Commission,Dapattmont of Public Works and oulor applicable permit granting authorities.