Case # _____________
Received
APPLICATION FOR PRELIMINARY SITE PLAN
APPROVAL
SITE NAME ________________________________________________________________
APPLICATION is hereby made for preliminary ______Amended
Preliminary______
Site Plan approval of plans for erection of a
building or buildings to be located in the ___________zone(s).
1. Applicant’s Name ______________________Phone
_______________Fax _______________
Address _____________________________________________________________________
2. Owner’s Name ________________________ Phone
_______________Fax _______________
Address: ____________________________________________________________________
3. Attorney’s Name _______________________Phone
_______________Fax _______________
Firm Name and Address ________________________________________________________
4. Name and address of person preparing
plans _______Phone ___________Fax ____________
Profession
Name
_______________________________________________________________________
Address
_____________________________________________________________________
5. Location:
____________________________________________________________________
(Street)
_______________________________________________ _____________________
(TAX MAP BLOCK)
6. Total square footage of building
___________ Total Square Footage of Lot ________________
7. List any zoning variances required and
if so, in addition, attach hereto as a separate rider your
factual
basis and legal theory for the relief sought.
___________________________________________________________________________
___________________________________________________________________________
8. Deed restrictions that apply or are
contemplated. (If no restrictions, state
“NONE”, if “YES”
attach
copy).
___________________________________________________________________________
APPLICATION FOR PRELIMINARY MAJOR
SITE PLAN
PAGE TWO
9. Plans for use of the proposed building
_________________________________________.
10. If
addition is used as a storage facility, please list materials that will be
stored. (If chemicals or hazardous materials are to be contained, please list
amounts, chemical name and common brand name:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
11. Briefly
describe any prior or presently pending proceedings before the
Planning
Board of any other federal, state, or local board or agency involving the
property which is the subject of this application>
_________________________________________________________________________
_________________________________________________________________________
12. List
any other material accompanying this application. i.e.
plans, drainage calculations etc.
_________________________________________________________________________
_________________________________________________________________________
13. List
any changes to the final maps that were not shown on the preliminary (if any).
_________________________________________________________________________
_________________________________________________________________________
________________________________
Applicant’s
Signature Date
CONSENT OF OWNER IF OTHER THAN
APPLICANT
I, the
undersigned, being the owner of the lot or tract described in the foregoing
application, hereby consent to the making of this application and the approval
of the plans submitted herewith.
Date
______________________ _______________________________________
WITNESS:
_________________________ _______________________________________
_______________________________________
Revised