Town of Rumford

Shoreland Zoning Permit Application

The undersigned applies for a permit for the Following use, said permit to be issued on the basis of the information 

contained within this application. The applicant herby certifies that all information and attachments to this application are true and correct.

1. Applicant:      

Name

AddressZip code

Telephone

 

2. Owner:

Name

AddressZip code

Telephone

3. Property location (describe or indicate on a map)

4.Map Lot

5. Existing use of Property:

6. Property is zoned as:

7. Is property part of a subdivision? Yes No

8.Proposed use(s):

A. Residence

B. Accessory building

C. Pier or dock (temporary permanent)

D. Clearing for approved construction

E. Private sewage disposal system

F. Filling or other earth-Moving activity of:

            Less than 10 cubic yards ,more than 10 yards

G. Other (explain)

9. Type of sewage disposal (existing) proposed

10. Percentage of lot to be occupied by structures:

11. Lot width Lot depth Lot area

12. Structure-exterior dimesions (length and width)

A. Residence By   Number of stories

B. Garage By  

C. Other By   Number of stories

12. Site Plan.     Illustrate the following information about your lot and the proposed use of the lot on a scale drawing or by a site plan prepared by a surveyor, architect, or engineer. ( Use Graph paper as in example shown.

A. Lot dimensions

B. Names of abutting property owners, name and location of abutting rights of way, public and private, and abutting water body.

C. exact location of existing and proposed buildings and distance from nearest lot line.

D Location of sewage disposal system and water supply.

E. Areas to be cleared, if applicable.

F. Areas of cut, fill, grading, or other earth-moving activity, if applicable.

13. Attachments

A. Attach a copy of pluming permit

B. Attach a copy of official decisions( or note pending applications) of other Federal, State or local agencies regarding the use of this property ( site Location Permit, Minimum Lot Size Waiver, Subdivision Approval, Great Ponds Permit, ect.)

C. On a separate sheet, attach any supplemental information, or explain any points you feel nee clarification.

 

To the best of my knowledge, all information submitted on this application is true and corrrect. all proposed uses will be in conformance with the application of the town of Rumford Shore land Zoning Ordinance.

 

Signature ______________________________________

 

  Date: