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Date Fil r-40,
G PERMIT APPLICATION
JAN 2 419%0 Ordina4ce Section 10 . 2
1 . Na nt :
A SP ra ,i7,�� �d_ : �� Telephones `5
K"i�%Iv
2 . Owner of Property ; T
Address : J-d, �#�f{�.> �, "r � i7a� X Telephone :
3 , Status of Applicant : Owner. Contract Purchaser �
Lessee Other (explain : )
4 , Parcel Identification : Zoning Map Sheet, _ Parcel
Zoning Districts)
Street Address
51 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
Parking Spaces
Loading Spaces
Signs
Fill (volume & location)
6.. Narratite Description of Proposed Work/Project: (Use
additidnal sheets U e sary)
i✓7 r' i h C S -' r /
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 : Applicant ' s signature:
THIS SECTIONrFOR OFFICIAL USE ONLY^ _ ^ -
Approved as presented
Denied as presented
Reason for Denial :
Signature of Building inspector.. Date