*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.

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 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:

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:

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.