*All permit applications and sketches must be fully complete and returned to the Zoning

Administrator with the appropriate fee, or they will not be considered complete.

PERMIT NUMBER:_________________ DATE______________________

The above Zoning Permit Number___________is hereby:_____Granted_____Denied

Reason for Denial______________________________________________________

Date of Action__________Effective Date__________By_______________________

Zoning Administrator

Westmore

Name of Applicant_______________________Telephone:______________________

Address_______________________________________________________________

Name of Landowner_____________________________________________________

Address_______________________________________________________________

Adjoining parcels owned by applicant________________________________________

Attach list of names and addresses of all owners of adjoining properties without regard

to public right-of-way.

911 Location___________________________________________Parcel Size________

ID No._____________Deed Recorded: Book____________Page(s)________________

Nature of Work: __New Construction __Addition __Alteration __ Change of Use

__Subdivision __Other Specify_______________________________

Existing Use_____________________________________________________________

Proposed Use____________________________________________________________

Existing Septic_____________________________Existing Water__________________

Property access (public road frontage, public water frontage, legal right-of-way____________________________________________________________________

Road Access Construction_____Yes_____No If yes, has curb-cut approval been

obtained from the selectboard?_____Yes_____No

Are there any private easements on the lot?_____________________________________

Is there any area of the property in question that is wet for more than two weeks of the year or that has running or standing water in, under, or on it?_______________________

THIS PERMIT DOES NOT RELIEVE YOU, AS APPLICANT, FROM OBTAINING ALL APPROVALS AND PERMITS AS MAY BE REQUIRED BY STATE OFFICIALS. PRIOR TO CONSTRUCTION.

Existing Use_____________________________________________________________

Proposed Use____________________________________________________________

Existing Septic_____________________________Existing Water__________________

Property access (public road frontage, public water frontage, legal right-of-way____________________________________________________________________

Road Access Construction_____Yes_____No If yes, has curb-cut approval been

obtained from the selectboard?_____Yes_____No

Are there any private easements on the lot?_____________________________________

Is there any area of the property in question that is wet for more than two weeks of the year or that has running or standing water in, under, or on it?_______________________

Lot Size (acres/dimensions) prior to subdivision _________________________________

Number of lots to be created ________________

Size of each lot created_____________________

Frontage of each lot created _________________

Depth of each lot created ___________________

Frontage(s) on public road(s), public water(s) or legal right-of-way_________________

A general plot plan showing the location of the property, the proposed new property lines, streets or roadways, easements or right-of-ways, lot areas and dimensions must be attached to the original and each of the three copies of this application.

Proposed Building Length__________Ft., Width__________Ft., Height__________Ft.

No. of Above Ground Stories__________

Setbacks from: Front Yard and Legal Right-of-Way_________Ft., Rear Lot________Ft.

Left Side Line_________Ft., Right Side Line__________Ft.

Do the proposed structures/improvements and proposed use include the addition of any bedrooms, bathrooms, or kitchen?____________________________________________

Attach detailed sketch plan, (see following Sketch Plan Requirements and Site Requirements).

The sketch plan must be a scaled drawing of the property, which contains the following information:

Property boundaries with dimensions.

Existing structures/improvements with identification of any to be removed.

Proposed structures/improvements with dimensions.

Distance between structures and property boundaries.

Location of private easements, if any.

Watercourses.

Steep slopes (over 15%) *See table 201 and Section 315.1A of the Westmore Zoning Bylaw (adopted August 31, 2000).

Wetlands

Location of wastewater disposal system. Refer to Section 315.3 of the Westmore Zoning Bylaw (adopted August 31, 2000) for special provisions regarding septic systems. See Page 4 of this Zoning Permit Application for septic certification.

SITE REQUIREMENTS

 

Property boundaries must be staked if within 40 feet of proposed structures or improvements.

All proposed structures or changes in footprints must be staked.

Location of wastewater disposal system must be staked.

*ONLY COMPLETED APPLICATION AND SKETCH WILL BE ACTED UPON.

APPLICANT/OWNER CERTIFICATION

The undersigned applicant hereby affirms that the information presented in this application is true, accurate and complete.

___________________________________________ ___________________

Applicant Signature Date

The undersigned property owner hereby consents to submission of this application and understands that if the application is approved, the zoning permit and any attached conditions will be binding on the property.

___________________________________________ __________________

Property Owner Signature Date

Conditional Use Approval is hereby:_____Granted Without Conditions

______Granted With Conditions

______Denied

Date of Action___________Effective Date__________By_________________________

Zoning Board Chair

Variance approval is hereby:_____Granted _____Denied

Date of Action__________Effective Date__________By__________________________

Zoning Board Chair

NOTICE OF APPEAL RIGHTS: Any interested person may appeal this decision by filing a written notice of appeal addressed to the clerk of the Zoning Board of Adjustment C/O the Westmore Town Clerk’s Office, within 15 days of the date of action noted above. A filing fee of $75 must accompany the notice of appeal.

Date of issuance______________ Date of Denial______________

Reason for Denial________________________________________________________________

Permit Expiration Date________________________

Zoning Administrator’s Signature:___________________________________________________

I am responsible for the design of the septic system located on property of _____________________at___________________________in Westmore, Vermont and hereby certify design compliance with the following:

There is a separation of at least 3 feet from the bottom of the disposal trench or bed to the high seasonal water table;

There is a separation of at least 4 feet from the bottom of the disposal trench or bed to bedrock or ledge;

There is a distance of at least 100 feet from the seasonal high water level;

There is a distance of at least 100 feet from the water supply source.

 

DATE: ____________________ Signature: _______________________________

I am familiar with the design of the septic system located on property of ________________at _________________________ in Westmore, Vermont and hereby certify design compliance with the following:

There is a separation of at least 3 feet from the bottom of the disposal system to the high seasonal water table;

There is a separation of at least 4 feet from the bottom of the disposal system to bedrock or ledge;

There is a distance of at least 100 feet from the seasonal high water level;

There is a distance of at least 100 feet from the water supply source.

DATE: __________________________ SIGNATURE: _______________________

$125 – Reconstruction, Conversion,

Additional rooms

$50 – Porches, decks, entryways,

Outbuildings

$100 – All other permit applications

$30 – Certificate of Conformance

required upon completion of all

construction.

The applicant herein requests a Zoning Permit, to be issued on the basis of the representations contained herein. The Zoning Permit issued shall be void in the event of any misrepresentation and the applicant shall be liable for fines for any work commenced under the falsely obtained permit. All construction or uses authorized by the Permit shall be completed within two years from the date of issuance. If the work is not completed within the allowed time, the applicant must fill out and submit a new application to complete the construction or use.