Permit Number ___________

Application for Zoning Permit

The undersigned hereby requests a zoning permit for the following use, to be issued on the basis of the representations contained herein. Permit will become void in the event of misrepresentation or failure to undertake construction within one year of the date of approval or completion within two years.


Owner of Record:
Applicant must be an owner of record, as shown in Mendon Land Records
Mailing Address:

Home Telephone:                                 Work Telephone:


Representative or Contact Person (if different):

Contact Mailing Address:
 

Contact Home Telephone:                         Contact Work Telephone:


Description of Property

The following information may be obtained at the Mendon Town Clerk s Office

Deed to this parcel is recorded in Book ______ Page ______ of the Town of Mendon Land Records.

Names of all Owners of Record



Location of Property (Road Name and Number)

Property Tax Map Description: Map _____ Block _____ Parcel ______ Lot Size: ________ acres


Description of Project
 

Existing Use and Occupancy:

Existing Number of Bedrooms:__________ Proposed Number of Bedrooms:__________

Proposed Use and Occupancy:

Nature of Project: New Construction _____ Addition _____ Structural Alteration _____
Swimming Pool _____ Deck _____ Tennis Court _____
Other (Please describe):

Approximate Completion Date: Value of New Construction

Building Description: Existing Proposed
Length __________ __________
Width __________ __________
Number of Stories __________ __________
Maximum height of highest finished floor level __________ __________

Total square feet of area:
Basement __________ __________
First Floor __________ __________
Second Floor __________ __________
Third Floor __________ __________
Loft(s) __________ __________
Deck(s) __________ __________
Porch(es) __________ __________
Other (please describe) ______________________ __________ __________

Setback from Road right-of-way: Front _______ Rear _______ Side _______ Side _______

Off Street Parking Area __________ square feet

Type of Water System Type of Sewage System

Disposal System Permit approved by Sewage Officer? Yes _____ No _____ N/A _____

Access Permit approved by Road Commissioner? Yes _____ No _____ N/A _____

A general plot plan showing the location and dimensions of the building, driveway, well and septic; a floor plan; and an elevations plan must be attached to this application.

 

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Signature of Owner of Record
At least one owner of record, as shown in the Mendon Land Records, must sign application

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
For Town use only
Application No.__________

Date Received ____________ Zoning Permit Fee ____________ Recording Fee ____________

Received By

APPLICATION FOR ZONING PERMIT: APPROVED ______ DENIED ______

Referred to Board of Adjustment or Planning Commission ______ Date_____________

Reason(s) for Denial or Referral:


Signed
Administrative Officer Date
An interested person may appeal any decision by the Administration Officer within 15 days of the date of such decision.
This permit shall not take effect until the time for such appeal has passed.