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TOWN OF MONTVILLE 01 7- /
•
Building Department
Application for a
Permit
(--72)
i Q� ►n)Gy4 \J}�e� �.�Rof9 Tel : ci ` 3G LS
Owner: u�rae>> � � � N�1 11 Address: �6
Job Location: ptra rS1, 3
Contractor: (IAA,tv P. Addreaa: Tel:
Stick Built: Modular Home: Manufactured Home: commercial:
Addition: _ Garage: _ Car Port: _ Shed: _ Remodeling: _ Roofing9
Siding: _ Fireplace: _ Chimney: _ Windows: _ Pool : _ Demolition:
Plumbing: _ Heating: _ Electrical : _ Air Conditioning: _ Gas:
Patio: _ Porch: Deck: New:New: Repair/Replacement: —
Type of Material to be uaed/job description: 1.` �- W�CI-. �t�"��T TORs'f"—
4
u9i0A OfinG) -P\yiArifyi
Size: 51( IC.) Type of Heat: Fireplace:
No.of Stories: / No. Rooma: Breezeway:
No. Bathe: Garage: Use:
'ASSESSOR'S MAP,NUTER LOT N[BER ,i EXPIRATION DATE 3 - '% j
ZONING PERMIT NLNBER
ZONING PERMIT
APPLICANT -Lfa`�1> ����L))=)
APPL I CAM'S ADDRESS r'_IZ c\J-c i C- I ELEPHONE M FER 6 - 3 6
PROPERTY OWNER
LOCATION LOT AREA ZONE ;- --4-/C)
BUILDING HEIGHT PRQPOSED FLOOR AREA
NATURE OF REQUEST/PROPOSED USE I /
HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY? LiYes I / No
Sketch below or provide two copies of plans drawn to a scale of at least l"=40' showing: dimensions of the lot, the
size, area, and location on the lot of existing, proposed, principal and accessory structures, driveways, sanitary
facilities and water supply, parking facilities, and adjacent streets; distances of proposed structures frau property
lines. In the case of fill or excavation requests (under 500 cubic yards), dimensions of fill or excavation area must
be included. A plan prepared by a Connecticut Registered land surveyor may be required. The proposed use specified
above shall not be authorized until an actual certificate of use and compliance is issued by the Commission or its
appointed agents. THIS PERMIT AUTHORIZES TIE APPLICANT TO PROCEED TO TIE BUILDING C PAZROTT F(J ANY REQUIRED PERMITS.
,„„)1 o U
.iurcef /
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THE APPLICANT AGREES TO:
1. Adhere to all the applicable requirgnents of the zoning regulations.
2. Notify the Carmission or its appointed agent of any alteration in the plans.
3. Contact the Zoning Officer (848-8549) at least 24 hours before construction begins to allow zoning officer to
inspect location.
4. Call for final inspection and request Certificate of Compliance before issuance of a C. 0.
/1/
Applicant's Ski gnature Date
THE LEIIERS NA (INDICATING "NOT APPLICABLE") SHALL BE NOIED IN LIEU OF A ZONING PERMIT N BER IN THE EVENT THAT A
ZONING PERMIT FOR THE PROPOSED USE IS NOT REQUIRED.
C ISSION AGENT " DATE
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