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ZONING PERMIT
IT IS THE OWNERS/AGENTS RESPONSIBILITY TO FURNISH THE FOLLOWING INFORMATION:
PROPERTY LOCATION 44 -blrCv, �QrraCst MAP IILOT RO
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X PROPERTY OWNER tt)-eSe. g 4 r/'I!-C ' PHONE#dn I"'-W-1- "if'41 V )(
XCONTRACTOR (,IS FMudle%rs /Jv( - ✓SC/r»cs J II(/YKix t,r' SPHONE# ,2D3._). "7D3-7
CONTACT ADDRESS I O`7 D Iv 1---0,,,,5 ill t/i.., I-3 liVo`1/iAl't s,j £ 06y41._ -7(-"3 - 67 S/ -e/ ' /
ZONE R LOT AREA +1-kb STRUCTURE AREA '/ HEIGHT
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NATURE OF REQUEST/PROPOSED USE O k-�14' Id"K A, It 4 -7- d<<-7-
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.
Office use only
YES N/A
SITE PLAN ❑ ❑
WETLANDS PERMIT
1�IGIcc_ ❑
HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY ❑ ❑
I HAS BOND BEEN FILED ❑ ❑
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FEE $ ` ( (l�11oc CASH/CHECK#
ZONING PERMIT NUMBER aMs •"" aI b OR N/A EXPIRATION DATE (d1P1'U-3
THE OWNER/AGENT IS RESPONSIBLE FOR AND AGREES TO:
1. FURNISH ALL NECESSARY INFORMATION AND DOCUMENTATION TO PROCESS APPLICATION.
2. ADHERE TO ALL THE APPLICABLE REQUIREMENTS OF THE ZONING REGULATIONS.
3. NOTIFY THE COMMISSION OR ITS APPOINTED AGENT OF ANY ALTERATION IN THE PLANS.
4. CONTACT THE ZONING OFFICER (848-8549 x-379) AT LEAST 24 HOURS BEFORE CONSTRUCTION BEGINS AND UPON
COMPLETION OF PROJECT TO ALLOW ZONING OFFICER TO INSPECT LOCATION.
5. AN E&S BOND MAY BE REQUIRED PRIOR TO COMPLIANCE SIGN OFF AND HELD UNTIL ONE YEAR FROM THIS DATE
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND FURTHER ATTEST THAT THE PROPOSED WORK IS
AUTHORIZED BY THE OWNS FEE AND TAT I AM AUTHORIZED TO MAKE APPLICATION FOR A PE/RMIT FOR SUCH DESCRIBED WORK.
)COWNER/AGENTS SIGNATURE 0/ A 4,1„4-_---
4-0, DA J (� U ET
6Y62+212DATE ,U (e(Qla 2£tL) y DATE z 31
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COMMISSION AGENT CERTIFICATE OF COMPLIANCE(COC)
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
REV05/24/2005
A