OWNER

APPLICATIONFOR A

BUILDING/USE PERMIT

TYPE OR PRINT

USE INK

BE COMPLETE

NAME

TOWN

APPLICANT (IF OTHER THAN ABOVE)

NAME.

TOWN

GENERAL CONTRACTOR

NAME.

TOWN_

LOCATION OF PROPOSED CONSTRUCTION

STREET

-_._--~

MAIL ADDRESS

STATE

lIP

MAIL ADDRESS

STATE

liP

MAIL ADDRESS

STATE

liP

MAP

PHONE (

PHONE (

PHONE (

LOT

ZONE

o RURAL RESIDENTIAL o SHORELAND o COMMERCIAL o COMMERCIAL FISHERIES & MARINE ACTIVITIES

TYPE OF WORK .

o NEW BUILDING 0 ADDITION 0 ALTERATION 0 REPLACEMENT 0 DEMOLITION 0 MOVING STRUCTURE

o OTHER DESCRIBE

PROPOSED USE

DONE-FAMILY 0 TWO-FAMILY 0 GARAGE 0 SHED 0 DECK 0 ADDITIONAL ROOM(S) 0 FENCE

OTHER USES- DESCRIBE

MOBILE HOME

MAKE MODEL NUMBER SERIAL NUMBER

OWNERSHIP

o INDIVIDUAL 0 CORPORATION 0 NONPROFIT 0 STATE 0 COUNTY 0 TOWN

COST

ESTIMATED COST OF STRUCTURE $

TO BE INSTALLED, BUT NOT INCLUDED IN ABOVE COST.

SEWAGESYSTEM $ WELL $ DRIVEWAY/PARKING AREA $ _

TOTAL ESTIMATED COST OF CONSTRUCTION

CONSTRUCTION TYPE

o WOOD FRAME 0 MASONRY 0 STRUCTURAL STEEL 0 REINFORCED CONCRETE OTHER.-------SEWAGE DISPOSAL

o PRIVATE (SEPTIC TANK) OTHER - DESCRIBE. _.,.

WATER SUPPLY

o PRIVATE (WELL, SPRING, ETC.) 0 PUBLIC

- 1 -

DIMENSIONS AND NUMBERS

PRIMARYBUILDING

OUTSIDE DIMENSIONS OF STRUCTURE{S) PROPOSED TO BE BUILT__ X __

GARAGE

__ X __

OTHER

__ X __

HEIGHT _ NUMBER OF FLOORS _ TOTAL SQ. FT. LIVING SPACE _ GARAGE _ OTHER __

NUMBER OF BEDROOMS NUMBER OF BATHROOMS - FULL _ HALF _

NUMBER OF PARKING SPACES - ENCLOSED _

LOT SIZE

OUTDOOR PARKING AREA _

FRONTAGE WIDTH FACING STREET FEET FRONTAGE WIDTH FACING SHORE FEET MINIMUM WIDTH FEET

MINIMUM DEPTH OF LOT FEET TOTAL LAND AREA SQUARE FEETOR ACRES

SQUARE FEET OF LOT TO BE COVERED BY STRUCTURE{S) _

BELOW FOR SHORELAND ZONE ONL Y ~

PERCENT OF LOT COVERAGE {IF MORE THAN 20%) _

PORTION OF LOT TO BE COVERED BY STRUCTURES AND NON-VEGETATED AREAS SQ. FT.

PERCENT OF LOT TO BE COVERED BY STRUCTURES AND NON-VEGETATED AREAS {IF MORE THAN 20%) _

PROPOSED ELEVATION OF LOWEST FLOOR, INCLUDING BASEMENT, ABOVE MEAN SEA LEVEL __ FEET, IF IN A FLOOD HAZARD AREA.

ADDrrtONAL PERMffS, APPROVALS, AND/OR REVIEWS REQUIRED

CHECK IF REQUIRED (NOTE: APPLICANTISADVISEDTO CONSULTWITHTHECODE ENFORCEMENTOFFICERAND APPROPRIATESTATEAND FEDERALAGENCIESTO

DBERMINEWHBHERADDITIONALPERMITS.APPROVALS,AND REVIEWSAREREQUIRED.)

o PLANNING BOARD ApPROVAL

o ExTERIOR PLUMBING PERMI~° INTERIOR PLUMBING PERMIT

o FLOOD HAlARD DEVELOPMENT PERMIT

OTHERS

0 ----0 _0 _0 _

APPLICANTS SIGNATURE

I CERTIFY THAT ALL INFORMATION GIVEN IN THIS APPLICATION AND ATTACHMENTS IS ACCURATE. ALL PROPOSED USESSHALL BE IN

CONFORMANCE WITH THIS APPLICATION AND THE OWL'S HEAD ZONING ORDINANCES. I AGREE TO FUTUREINSPECTIONS BY THE CODE

ENFORCEMENT OFFICER AT REASONABLE HOURS.

ApPLICANT'S SIGNATURE

- 2-

:t!. DATE _

- 3 -

SITE PLAN

ILLUSTRATETHE FOLLOWING INFORMATION ABOUT YOUR

LOT BY MEANS OF A SCALE DRAWING ON THE GRAPH PAPER

BELOW.

o DRAW PROPERTY LINES, SHOWING DIMENSIONS.

6 SHOW ABUTTING RIGHTS OF WAY (PUBLIC AND PRIVATE),

ANY ABUTTING WATERBODY, AND NAMES OF ABUTTING

PROPERTY OWNERS.

E) SHOW EXACT LOCATION AND SIZEOF EXISTING AND PRO­

POSED STRUCTURES, GIVING DISTANCES TO NEAREST LOT

LINES.

o SHOW LOCATION OF WATER SUPPLY AND SEWAGE SYSTEM

WITH DISTANCES TO NEAREST LOT LINES.

(;) DRAW ARROW POINTING TOWARDS THE NORTH OF YOUR

SITE PLAN.

DRA W TO A SCALE OF If. INCH (ONE SQUARE) = 10 FEET;

EXAMPLE DRAWING

I

THIS PAGE FOR OFFICE USE ONLY

DATE RECEIVED------------------

DATE OF ACTION ON APPLICATION,---''-- _

o ApPROVED -,0 DENIED

IF DENIED, REASON FOR DENIAL. _

IF APPROVED, THE FOLLOWING CONDITIONS ARE PRESCRIBED' _

CODE ENFORCEMENT OFFICER _

PLANNING BOARD (IF APPLICABLE) _CHAIRMAN

DATE _

DATE. _

"

INSPECTION CHECK USTDATE COMMENTS

0 PRIOR TO CLEARING AND EXCAVATION _

0 PRIOR TO FOUNDATION FOOTING POUR _

0 PRIOR TO OCCUPANCY _

Check List/Enclosures

Notice for new residences _Subsurface Waste Disposal permit for new residence/change of use__DEP penn its in Shoreland Zone ---DOT penn its for new driveways on State-Aid roads _

4. Rev. 4/00