23D-141 (7) FILE # J 112 0 5
APPLICANT/CONTACT PERSON: X1 7�/ nu ` ' _SfL_
ADDRESS/PHONE:
PROPERTY LOCATION: / 9t i' 'lt�J � it `
MAPS D PARCEL: j 1/ a ZONE .��-er--
I'HIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
l ENCLOSED REQUIRED DATE
ZONTNr FORM FTTJ.F. O 114f�Z
Rat► f cling Permit Filled Tur S
Fee Pairs
Type of C'nnctrurtinn•
New Construction
Resmrseling Interior
Addition to Fxicting
Accessory Strurture
Ruilrsing Plane Tnrliiders•
Owner/Orcupant Statement or Licence #
3 Sets of Plans I Plot Plan
THE EQLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented *Note: Needs to be surveyed & staked (garage
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-Bd of Healt Well Water Potability-Bd Health
Pe 't fro /` • s;•ion
8/2 /
Signature of Building ector Date
NOTE:issuanoe of e zoning permit does not relieve an applloant's burden to oompty with all
zoning requirements end obtain ell required permits from the Board of Health, Conservation
Commission, Department of Public, Works and other applioable permit granting authorities.
r
File No./o?l7 5 r
ZONING PERMIT APPLICATION (510 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: r L �� cJ F1-7.1
Address: / 6 6 0-7 tiJ G4 LC7 17--- Telephone: y/ 3 - - Y
2. Owner of Property: 3 — a L/ L-r
Address: ° Telephone: a
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# 2.3.D Parcel# !4 / District(s): V /28
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property /L- y / 6-
C_C__
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
DL—'A-10 L I S/4 C-4-72 PO i2.7— /
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.
8. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO DONT 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 ✓ DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? 4/,/-f
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: A' //2-
Are there any proposed changes to or additions of signs intended for the property?YES NO k
IF YES,describe size,type and location: Ai/ 4_
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This co/a to be f17Led in
by the Braiding' Department
Required
Existing Proposed By Zoning
Lot size
?"r`- //- a /p crop
Frontage k3• S� S
Setbacks - front 2 2 / 2 6 f Z C)
- side L: t/ R: (C/ L: 7 R: /
- rear
3 ' ' ZG ' 2—
Building height
Bldg Square footage �z ?_
/h Y ��//SGe o.r/r(IF 5-0 .Jo
%Open Space:
Lot area minus bldg&paved parking) S-6 O ,/6
0 Q,
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location) /V//-
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: � �' Z APPLICANT'S SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an applicant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public) Works and other appiioable permit granting authorities.
FILE #