PB 24 06 PB Application

TOWNSHIP OF WEST ORANGE APPLICATION FORM FOR THE PLANNING BOARD OR ZONING BOARD OF ADJUSTMENT A. APPLICANT INFORMATION Full Legal Name:__ 410 MAIN ST HOLDINGS LLC (Last) First) Mailing Address: 6 Emma Lane Jackson NJ 08527 (Street) (City) . State) (Zi Telephone Number: (201) 883-1010 (attorney) Email: ben@primelaw.cos ) Is the Applicant an: O) Individual, OX Corporation, C) Partnership, O Other Ifthe Applicant is a corporation or partnership, a list of the names and addresses of persons having a 10% interest or more in the corporation or partnership must be attached, Relationship of the applicant to the property: [ Owner, O Tenant or Lessee, O Purchaser under contract (with consent of owner, 1 Other (please specify) If the applicant is not the owner of the property in question, the applicant must submit an affidavit with the owner(s) authorization to proceed with this process. B. PROPERTY OWNER INFORMATION ( Check here if same as applicant. If the owner is not the applicant, please complete the following: Owner’s Name: Address: Telephone Number: (___) Email: C. PROPERTY INFORMATION Street Address:_410 Main Street Block Number(s): 113 ; Lot Number(s): 262, 264 & 308 5 Tax Plate: 0061 ; Zone of Property: _B-2 The location of the property is approximately _( feet from the intersection of Main Street and Park Drive N (closest intersection.) Has there been any previous Zoning Board of Adjustment or Planning Board hearings involving this Property? Q Yes, Date(s): ; (XNo If yes, please attach copies of the written decisions adopted by the Board to each application. Please attach a list of all contiguous or adjacent property owned by the applicant or owner, CX None Is this property listed in “The Historic Sites Survey” prepared by Robert Guter 7/9/1992 0 Yes EXNo TAPLANNING BRO\Dacument Library\PO-ZUA Application 4-20-1S.doe