43-064 (3) ,' 0002At •
Date Filed `� 6. File No.
ZONING PERMIT APPLICATION (510 . 2)
1 , Name of Applicant : /&]/ A-,:7 CJ_ a- bieki t2. jw
Address : S-- Z>L'*JP.1/4 F(512./VE Telephone: S3C- - 7et6
2 . Owner of Property : /C,!Gvt_`f-T (_t , i- Neil( r'. /C4-
Address: 1/7 7)L2NPH/ ! ('ivr Telephone : 576-- 04.%
3 , Status of Applicant: ✓Owner contract Purchaser
Lessee Other (explain:
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4 . Parcel Identification: Zoning Map Sheet# LIS Parcel# C GJ/ r
Zoning District (s) (include overlays)
Street Address 'I? /9( 1Y // Jk-C.
Required
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g , Exis in4 Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg , Coverage (Footprint).__
Setbacks - front _
- side ( J2 L R
- rear
Lot size ..
Frontage •
Floor Area Ratio
%Open 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) 22 45'V rr/. oNH Fr_'Cr f'tNM /cJ? THE'
PUQf'ese of //Mid Sryti&Vs. /A);7.9z r- ON?: 5141k CTJ9t 14)76 /1r7Lrir/NG
434-7b foj r''UMSM,I(iJ, /WO Poss7di-9 at4C-Ny92f )4117h (Ny SNariE,C)
cz7/2E /4V/4- rJ✓f",('-714.4 ti 7/,U(
7 . Attached Plans : Sketch Plan Site Plan
S . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge_
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Date : `/i0 - Applicant ' s signature : /cj,4, g•
THIS SECTION FOR OFFICIAL USE ONLY
Approved as presented/based on information presented
_/Denied as presented /
Rep-o for t`nial : fi7
S gna u = . Build - .r Date
NOTE:issuance of a • .g pormi does not rNl€ve an npplloanns burden to comp),with a zoning toquimments and obtain all required permts
from the Dowd o(lie ih, Conservation Commiostan, Popamnonl of Public Works end ower applicable porrnit wording autoftlos.
• 7/92 PXAS