38B-009 (5) 002342
Date Filed 4 File No.
ZONIPG PERMIT APPLICATION (510 . 2)
1. Name of Applicant: P4� 77�
Address:,f-og XJC7,&-j; F ( g:7_->. Telephone: 5-' r,1
4g 4,7 S — -- &I
F-Lot2ewcu) MA -
2 . Owner of Property: A.1A-,--7,QA2A-1_
Address I_1A_W,.-7vAJ al A Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee _X Other (explaTn. &-j,�As ?)
4 . Parcel Identification: Zoning Map Sheet# -46 Parcel#
Zoning District(s) (include qverlayk44
Street Address
Required
5. Existing Pronosed —by Zoning
Use of Structure/Property (!2 r'El C 4r
(if project is only interior work, skip' o #6)
Building height
tBldg. Coverage (Footprint)
Setbacks - front
- side L: _R: _L:_R:
- rear
Lot size
Frontage
Floor Area Ratio
tOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) f3,04,14 OF-E-71C27
&442 -WU�i r A-i
7 . Attached Plans: D4 Sketch Plan Site Plan
S . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledg, .
Date: Applicant's Signature:
- - - - - - - - - -THIS - - -
�_ _ SECTION- '- FOR OFFICIAL_ " USE ONLY:- - - - -
Approved as presented/based on information presented
i,'Oenied as presented--Reason:
Special' Permit and/or Site Plan Re
i i
n Variance Roquire.d:
9
rc
4S --a
gZnz�p r of Building Ins or
to
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 Houlth, conservation commission, Department of Public Works and other applicable permit granting authorities.