Crestmont Application Package modular home 5124

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. 1 am aware that if any of the foregoing statements are willfully false, I am subject to punishment. Applicant’s sume A=) QD Date: if vf ia 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. — 4 sets sone 2 Z—_— Date: f: of ay OWNER’S AUTHORIZATION — MUST BE SIGNED Thereby certify that hersitsca RY business address is 750 Eagle Rock Avenue, West Orange, NJ 07052 in the County of __Fssex and the State of New Jersey sand that I am the owner of all that certain lot, piece or parcel of land known as Block(s) 174_| : Lot(s) 1.01___ 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 of this application. Owner’s Signature: ae Date: fof 21¥ Crestmont Country Club 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\Document Library\PB-ZBA Application 3-15-18.doc PA