39A-76 (41) FILE 1 960527
APPLICANT/CON TACT PERSON: _I ' - Imo, LI . r' V -',_.5Q�(n
ADDRESS/PRONE: /1.3 ,- Cz)-7Q724.?e( . '�1 '�
PROPERTY CATION: 49C2 _ f c� z _ ' //(L� �
MAP s��f _ PARCEL: 7(e ZONE (-/j'
TEES SECTION FOR.OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.ONTNG FORM FIT,T,F.T) OTT . ✓ 02 r
FP PAId l .CJ , 0 . ` -
/ n
w�
Fee ' .-. MU 11 '
Type of Cnnctrnrtinn• 'OTE• 'i„,,i- t - Laa. AA 1Qt — _
1
New Cnnctrnrtinn /
Remndding I terinr
Additinn to Evicting
Arccsnry Strurtiire
Building Plant Tnellided• _ ,.
Owner/Orrupont Statement nr T.irence#
3 Setc of Pinn/ Plat Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP' ICATION:
Approved as presented/based on information presented
Denied as presented:
7
Special Permit and/or Site Plan Required under:§
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed_
FindingRequired under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
I
� /
Y Variance Required under: § 7, - 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 Health - Well Water Potability-Bd Health
' /Permit fro • :use_.tion Commission 'y
impr
•ignature of:ui 4 g Insir -- ate
4100111°
NOTE:lssuanoe of a zoning permit does not relieve en applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioable permit granting authorities. —