38A-007 (4) i
10. Do any signs exist on the property? YES NO a
IF YES,describe size,type and location:_ tjL-
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:4A
11 . ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This C01U= to be filled in
by the Building Llepartment
(Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: 4A R: I L: R:
- rear
Building height IL '
Bldg Square footage Gv�
%Open Space:
(Lot area minus bldg
&paved parking; ;j
# of -Parking spaces
ht of Loading Docks
Fill:
-(volume -& location)
A
i
13 . Certification: I hereby certify ';that th6*nfo mation contain ed herein
is true and accurate to the best of my k ge.
DATE: L 1 � 'i ) APPLICANT's SIGNATURE ( ��t—
NOTE: Is uanoe of as zoning permit does not irelieve an applicant's burden to oompty With all
zoning requlrements and obtain all required!;permits from the Board of Health. Conservtation
Commission. Department of Publio Works and other applionble permit granting authorities.
FILE #
>� Fi 1 e No. 9� L-)
FP1 , BtIl C
T .S
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: -�Ip UI.3(--Q- - Telephone:
2. Owner of Property: La J L s
Address:- S?- Telephone: 4 6 z-3
3. Status of Applicant: Owner Contract Purchaser ✓Lessee
Other(explain):
4. Job Location: S-Z, L -vc-,Q
Parcel Id: Zoning Map#_�,20 _ Parcel# District(s): �JL
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
FL,-c- ��l.� �3`S Q o�.s U a�� 1� !L L�3�,.- ,P.,a^:;Z La Q I v c C�L a `-sue r
.r"o Q L/ C 613V`S
7. Attached Plans: vV�LA, Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Vadance/Finding ever been issued for/on the site? A)/jQ
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE # 96 3044
6241997
DEPT QF,g� �Ip /CON CT PERSON: �,,?6=,3n2?O
No�!-f�lMt?A'i� P7E: o
PROPERTY OCATION:
MAP PARCEL: rJ ZONt
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMUP APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Rnilding Permit Filled mit
Fee PAid
— Addition to Fxisting
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
S Approved as presented based on information presented *not to exceed 1 year
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD 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 He Well Water Potability-Bd Health
�r n ission
Signature of Building Inspector Dite
NOTE:Issuanoa 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 Public Works and other applioabie permit granting authoritles.