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ZONING PERMIT
IT 0 THE APPLICANT'S RESPONSIBILITY TO FURNISH THE FOLLOWING
INFORMATION:
PROPERTY LOCATION /5 v "4MAP )� LOT GJ�
PROPERTY OWNER (fr/74�, (--;)::4,7/71/474:4,7 /?%,/a /l
CONTRACTOR /2' 75-6i (-:-.77 y))/CO1NTRACTORLICENSE# �p�7
CONTACT ADDRESS /7e7 ��r A�� cy44PHONE ��
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ZONE LOT AREA STRUCTURE AREA HEIGHT \ - -
NATURE OF REQUEST/PROPOSED USE J - ,11CGJ !'. (✓rs,
✓ 1 a5Z42 rJc c%
A SICETC H,OR PROVIDE TWO COPIES.OF PLANS DRAWN TO A SCALE OF AT LEAST 1'=40'SHOWING:DIMENSIONS OF THE LOT,
THE SIZE,AREA,AND LOCATION OF EXISTING,PROPOSED,PRINCIPAL AND ACCESSORY STRUCTURES, DRIVEWAYS, SANITARY
FACILITIES AND WATER SUPPLY,PARKING FACILITIES,AND ADJACENT STREETS;DISTANCES OF PROPOSED STRUCTURES FROM
PROPERTY LINES AND WETLANDS. A PLAN PREPARED BY A CONNECTICUT REGIS!EKED LAND SURVEYOR MAY BE REQUIRED.
THE PROPOSED USE SPECIFIED ABOVE SHALL NOT BE AUTHORIZED UNTIL AN ACTUAL CERTIFICATE OF COMPLIANCE IS ISSUED
BY THE COMMISSION OR ITS APPOINTED AGENTS.
Office use only
YES N/A
SKETCH PLAN OR GRADING PLAN •
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HEALTH DISTRICT/WPCA APPROVAL `r'* ❑
STATE HIGHWAY PERMIT 0
WETLANDS PERMIT ❑ "L1
HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY
HAS BOND BEEN FILED ' co— 4 Ub(oloSto< ❑ CKr
FEE C2r, CAS HECK# ❑
•
ZONING PERMIT NUMBER e9UP OR ON/A EXPIRATION DATE q /e
THE APPLICANT IS RESPONSIBLE FOR AND AGREES TO: /f
1. ADHERE TO ALL THE APPLICABLE REQUIREMENTS OF THE ZONING REGULATIONS.
2. FURNISH ALL NECESSARY INFORMATION AND DOCUMENTATION TO PROCESS APPLICATION.
3. NOTIFY THE COMMISSION OR ITS APPOINTED AGENT OF ANY ALTERATION IN THE PLANS.
4. CONTACT THE ZONING OFFICER t848-8549) AT LEAST 24 HOURS BEFORE CONSTRUCTION BEGINS AND
UPON COMPLETION OF PROJ CT TO ALLOW ZONING OFFICER TO INSPECT LOCATION.
APPLICANT'S SIGNATURE /VJ - DATE-
F :- 9 ✓ DATE r/C)Z - e / DATE 5/VA-3
COMMISSION AGENT CERTIFICATE OF COMPLIANCE
THIS SIGNED PERMIT AUTHORIZES THE APPLICANT TO PROCEED TO THE BUILDING DEPARTMENT FOR ANY REQUIRED PERMITS
THE SIGNED CERTIFICATE OF COMPLIANCE IS NEEDED PRIOR TO A CERTIFICATE OF OCCUPANCY BEING ISSUED BY THE BUILDING
INSPECTOR
ISIX)C\ re,.le_c(se8 Ibrva a, 2-043
REV. 6/29/99
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