Application No.
TOWN OF
LAND USE AND DEVELOPMENT
PERMIT APPLICATION
Please
type, or print legibly in ink
(3 Pages
plus Deed)
Applicant:
Name: (print) ____________________________________________________________
Address: ____________________________________________________________
____________________________________________________________
____________________________________________________________
Telephone: Day:_____________________
Evening:__________________________
Property and ownership
Tax map parcel number:
Are you the owner of the property? Yes___ No___
If not
please note relationship to property (for example “architect”, “agent”,
“lessee”, etc. and owner’s full name, address and telephone number): ___________________________
________________________________________________________________________________________________________________________________________________
Location of property: (Mailing
address, if any. If there is no mailing
address for the property, describe the location by naming the road or roads
adjacent to the property and the direction and distance from the nearest
intersection or other landmark):
________________________________________________________________________
Description of the present use and the proposed use of
the land (for example “single family residence with garage”)
Proposed new or additional use:
New building___
Addition___ Alteration___ Repair___
Removal___ Demolition___
Site modification ___-Septic system modification or
installation___
New or additional business use___ Other use or additional
description: ______________
ATTACH A PLOT DIAGRAM (SEE ATTACHED SAMPLE AND FORM)
The information above and attached is an accurate
description of my planned land use.
Signature: ________________________________________
Date:________
Application fee (to be paid
when application is submitted):
New
homes/structures: $25.00 Additions or
alterations: $10.00
Please Make Checks Payable
to the Town of
LAND USE AND DEVELOPMENT
PERMIT APPLICATION
PLOT
DIAGRAM
Existing structures: New structures
or installations:
Road
centerline:
Property line
Show all existing, and all proposed new or modified
structures or installations. For each
new structure or installation, show distance from nearest existing structures
on the property, and setbacks ( shortest distance) from adjacent property lines
and road centerlines. Show any other
important site features on the diagram (for example, ditches, driveway,
existing septic system, etc.) Attach a
separate sheet if you need more space.
LAND USE AND DEVELOPMENT
PERMIT APPLICATION
Number each new or modified structure or installation on the diagram and describe below
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No. |
Use/Description |
Length |
Width |
Height |
Modifications |
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