30B-073 (10) File#MP-2000-0078
APPLICANT/CONTACT PERSON ELLIS STEVEN
ADDRESS/PHONE P O BOX 382 586-4866
PROPER
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM F LED OUT
d 7°1 ,65/0
Building Permit Filled out
Fee Paid
Typeof Construction: 1ST FLR VETERINARY PRACTICE&2ND FLR APARTMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING 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
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 Board of Health Well Water Potability Board of Health
Permit from Conservation Commission
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
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DM Of Bbii.0 is File No.
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ZONING PERMIT APPLICATION (§20 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: r/tiiL%Ll i`t
Address: >REClccw 2 .06E jZd (a.,al.<. Telephone: =-.Stio . `( TV, 6
2. Owner of Property: h'..ss.-V t' ser.v
Address: Z7.T{ - r..et. S� Jnr ,-.;�-,_ Telephone:
3. Status of Applicant Owner .Y' Contract Purchaser_Lessee
Other(explain):
4. Job Location: -4 Sr /hi �
�_k4.�
/
Parcel Id: Zoning Map# 3 p v Parcel# 3 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property tie k.:,,.4 . ?re� rick
140,- t ...,_r 2.4S n.k ti,d:< c:.k. ,L<
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
C., '-. c \ Slain Den— $ Jek . +Lr 9rriu
, hk a S .rko., ctt. rss ,bse
0LAM - 4l( : r c Sint
7. Attached Plans: 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.
S. Has a Special PermiWadancefinding ever been issued for/on the site?
NODON'T KNOW_ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO X DONT 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 X NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO k
IF YES,describe size,type and location:
II. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This coli to be fitted in
by the Building Departhan t
Required i
Existing Proposed By Zoning
Lot size (72 3) - 60
Frontage
Setbacks --frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
•
# of Parking Spaces
#` of Loading Docks
Fill:
(volume-& location)
13 . certification: I hereby certify that the information contained herein
is true and accurate to the best of my know e.
DATE: Q-( 21 45 APPLICANT's SIGNATURE
NOTE: las of a zoning permit does not relieve an app ants 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 applicable permit granting authorities.
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