23C-055 82 Willow-2YES ___,NO VAre there any proposed changes to or additions of signs intended for the property?
IF YES, describe size, type and location:__-.-:..______~__________'_____'___
11. WifJ the,construction activity disturb (clearing. gradi,ng, excavation. or filling) over~ acre or is it part of a common
plan of development that will disturb over 1 acre? YES__ NO '_V_ . ,
IF YES, then a Northampton Stor~ Water Management Permit from the DPW is required.
12. ALL INFof?MATfON MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATIOr~
L l' \.1., \ lA' . . This column reserved .
,,;;.... Jt,jlIJt (\J.D i1 r\ ': for uSeb;y-theBWlding
---~~~------
25 J -10 '1ifltt:r 25''' 9i1UtI
Side l: Iqo' R: ~O' l: ,qO' R: 5"5'""
Rear
/V 25"0" /V 'L)"O'
/:130
()
o
13. certification: , hereby certify that theinforll1ation contained herein is trUe and accurate to tiiebest of
my knowledge. '.
-o;,te:~ t><Jjt'f\tz::---APpl~Siii!"'"'" .J#~~--.-'-------------------.~---
NOTE: Issuance ofazonfug pennttdoes not relieve anapplic~t'sburde~to coxnplywithaII zoning "
, . requirelIlents and obtainal! rE~quired permits from the Bo(lt'd.ofHeaIth, Conservation Commission,
, "HiS,tofic:and ArcliitocttiraIBoards, Department of'Public Works and other applicable permit granting
authorities. . , .'... . , '
W:\DDcuments\FQRMS\OriginallBuilding-Inspector\Zoning.Petmit-Applicalion-p~ive.doc 8/412004