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32C-044 (7) FIT.F I rnLn 4 03 / APPLICANT/CONTACT PE t. " N: t'el-cf'Cf- 92617"4-)" `-r � (i7o/5- ADDRESS/PRONE: ' i to `772U r-PeA PROPERTY LOCATION: / �' -C� gi '. MAP ,.307(_ PARCEL: (J .._. _. ZONE C13 TRIS SECTION FOR OFFICIAL USE ONLY: . PERMIT APPLICATION CHFCICLIST ENCLOSED REQUIRED DATA: ZONING FORM FTI T.FT) Mr Fee Paid ...... OriiY 4.1'... C— RpildingPnrtnit Filled mit _ Fee Paid , Type of Cnnetnmrrtioc:Yao*-a 4--4I;a-la-Le- , _ New Cenatrnetiq• et v. i - •`P't-e -.. _— .Rem ridding Tnterinr Addition to F.ticting Accessory Strnrto re Rnilding PIBAc Tnrlmled• _..... Owner/Om-typo nt Statement =.ire[ige tt� A — . i . ' . . 'Int Plan TE31;,pOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: ? _//Approved as presented/based on information presented 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 r Variance Required widen§ 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-Rd of Health ater Potability-Ed Health Pernik from Cense. tion C m�� -� /-� , ' LC / Signature of Building lnspe ...... D e NOTE:Issuance of a zoning permit does not relieve an applicants burden to comply with all rotting requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities. — 5 J � is File No. &5490 ZONING PERMIT APPLICATION (510 . 2) PLEASE TYPE OR ERDJT ALL INFORMATION I. Name of Applicant: Address: w > �. Telephone:_... ( IS�..... 'C- Q. 2. Owner of Property: 4cc.r, Address: f 3'i l /m `> i ..__.._Telephone: ;s/q -q t ci -..-... 3. Status of Applicant: Owner 17- Contract Purchaser Lessee Other(explain): 4 Street Address: /G- ?/cce;crAL._ - Parcel Id: Zoning Map#� .� Parceik_C'y" V District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property �e..� t22CFir>1y c")lck{e eN 6. Description of Proposed UseNNork Proiect/Occupeton. (Use additional sheets it necessary): ce+tiT-Tru SiCtdu:. Xue ... Slee/ iccenc_. fl.;-) ..�..' s[t•n _ Slat- 7. or7. Attached Plans: Sketch Pan Site Pias Engineered/Surveyed Pians Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. Has a Special Permit/Variance/Finding ever been issued far/on the site? 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 andtorfDocument# 9, Does the site contain a brook, body of water or wetlands? NO YDDON'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) 10. Do any signs exist on the property? YES NO,,,,,,,,, IF YES,describe size, type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO IF YES,describe size,type and location: IZ . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This col= to be filled in by the Buil Alnp Department Required Existing Proposed By Zoning Lot size . r 1 9 Frontage — � 1 Setbacks - frnntCJJ? - side L: CO R: Cv L: c[r R: Cit D - rear Bu —7 t 117........_ gilding height act 3c JC - Bldg Square footage _soca 79 %Open Space: / F '(Lot area minus bldg &paved parking) Z3 ' I`��.-J c?,3 y (, pf Parking Spaces • • # of Loading Docks Fill: -Qvol-rime--& location) 13 . certification: I hereby certify that the intonation contained herein G is true and accurate to the best of my knowledge. DATE: ,2d Ad APPLICANT:s SIGNATURE ,,,,A NOTE: lase oe ot a zoning permit does not relieve an applicants burden to compty with a� zoning requirements and obtain all required permits from the Board of Health* Conservatic Comtnisalon„ Department of Public Works and other appiloabie permit ranting authorities. FIG? # ._ ci-aNS >7 ! Q O-10.ro oa\U ki .tcoad c3a>c,t6c vots6 1©1 'CM—'v,4,) 9 kc . 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