Note: Completion of the applicant's portion of this application does not guarantee that a zoning permit will be issued. This application will be used to determine if your project complies with the Zoning Ordinance.

Date:                                        No.             (Issued by Zoning Dept.)
Name of Applicant
Mailing Address
Phone #
Property Owner's Name
Mailing Address
Phone #
911 Site Address or Adjoining 911 Addresses                                   Tax Map Number
Proposed Use of Property:
Source of Water Means of Sewage Disposal

Attach a Site Plan showing the following information:
a. Shape and dimensions of lot
b. Existing structures with distances to lot lines.
c. Dimensions and locations of all proposed buildings or structures (including additions or alterations) with distances to lot lines.
d. Existing and intended uses of the land and of each building or pan of a building
e. Significant natural features, such as woods, streams, etc.
f. Existing and proposed roads and driveways
g. Existing public water and sewer lines
h. Off-street parking spaces (Section 4-10)

Date                                           Signature
For Office Use Only: