PB 22 08 Cummings Application Package

J-VERIFICATION AND AUTHORIZATION — SIGNATURE IS REQUIRED FOR ALL OF THE FOLLOWING: APPLICANT’S VERIFICATION I hereby certify that the above statements made by me and the information contained in the papers submitted in connection with this application are true, I am aware that if any of the foregoing statements are willfully false, I am subject to punishment. Applicant’s Signature: Date: CONTINUANCE Should the Planning Board/Zoning Board of Adjustment have a full and heavy agenda, or discussion and meeting regarding this application requiring carrying the matter past the statue time limit, the applicant grants permission for such an extension. Applicant’s Signature: Date: OWNER’S AUTHORIZATION — MUST BE SIGNED Thereby certify that I resitteat _have a business address of 271 Mt. Pleasant Avenue, 4th Floor, West Orange in the County of Essex and the State of _New Jersey ; and that I am the owner of all that certain lot, piece or parcel of land known as Block(s) 80.03 Lot(s) _10 and 21 on the Tax Map of West Orange which property is the subject of the above application, and that said application is hereby authorized by me. Furthermore, I authorize inspection of the site which is the subject Wave Owner’s Signature: (0 — Date: S [ w/ ae Mount (le Covvees Conf : een Qua } each lot to comply with 30% max coverage THIS APPLICATION DOES NOT RELIEVE THE APPLICANT FROM COMPLYING WITH OTHER TOWNSHIP ORDINANCES SUCH AS THE TREE REMOVAL ORDINANCE AND OBTAINING THE NECESSARY APPROVALS AND PERMITS UNDER SUCH ORDINANCES. TAPLANNING.BRD\Dacument Librar\PB-ZBA Application 4-20-15.doc aS