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ZONING PERMIT
ZONING PERMIT NUMBER OR gN/A EXPIRATION DATE
PROPERTY LOCATION 4 Il e,tji /� L`�C,ahs , d! l/11- G / MAP re LOT G
PROPERTY OWNER a G ij /j 6-1 a a , ? dc, y'
CONTRACTOR .,5e- / CONTRACTOR LICENSE#
CONTACT ADDRESS 5"' l TELEPHONE
ZONE LOT AREA a g e;
PERMIT REQUEST 5-X /c} ✓/e• I
IT IS THE APPLICANT'S RESPONSIBILITY TO FURNISH THE FOLLOWING INFORMATION:
A SKETCH, 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
REGISTERED 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.
SKETCH PLAN OR GRADING PLAN [YES ❑N/A
HEALTH DISTRICT APPROVAL DYES FINV/A
STATE HIGHWAY PERMIT DYES [�]N/A
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WETLANDS PERMIT DYES [JN/A
HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY DYES WO
HAS BOND BEEN FILED DYES ON/A
FEE p CASH D CHECK# NIA
THE APPLICANT IS RESPONSIBLE FOR AND AGREES TO:
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. CALL FOR FINAL INSPECTION AND REQUEST CERTIFICATE OF COMPLIANCE BEFORE ISSUANCE OF C.O.
APPLICANTS SIGNATURE 12(_ —�E � -�j' --�` DATE: i /5 7
7.
7-40-0Et24.10. 20cDvif
COMMISSION AGENT DATE CERTIFICATE OF COMPLIANCE DATE
THIS SIGNED PERMIT AUTHORIZES THE APPLICANT TO PROCEED TO THE BUILDING DEPARTMENT FOR ANY REQUIRED PERMITS
CONTACT THE ZONING OFFICER (848-8549) AT LEAST 24 HOURS BEFORE
CONSTRUCTION BEGINS TO ALLOW ZONING OFFICER TO INSPECT
LOCATION.
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