Revised Application Signed 72924

TOWNSHIP OF WEST ORANGE APPLICATION FORM FOR THE PLANNING BOARD OR ZONING BOARD OF ADJUSTMENT A. APPLICANT INFORMATION Full Legal Name: Crestmont Country Club, Inc. ——_ (Last) (First) Mailing Address: 750 Eagle Rock Avenue. — (Street) (City) West Orange (StateJNJ (Zip)07052 Telephone Number: (973_)232-5061 (attorney_)Email: tick@schkolnicklaw.com Is the Applicant an: C] Individual, Corporation, [7 Partnership Other_X - 501C7 Not for Profit If the 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. **See attached disclosure Relationship of the applicant to the property: Owner, Tenant or Lessee, [Purchaser under contract ( with consent of owner, [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 O Check here if same as applicant. If the owner is not the applicant, please complete the following: Owner’s Name; Same as applicant — Address: Telephone Number: ( ) Email: C. PROPERTY INFORMATION Street Address: 750 Eagle Rock Avenue Block Number(s): 174. ; Lot Number(s): 1.01 3 Tax Plate: 121 ; Zone of Property : R-2 The location of the property is at intersection of Eagle Rock Avenue and Laurel Avenue and__ (closest intersection .) Has there been any previous Zoning Board of Adjustment or Planning Board hearings involving this property? X Yes, Date(s); See attached resolutions of approval + No Tfiyes, please attach copies of the written decisions adopted by the Board to each application. o ae Please attach a list of all contiguous or adjacent property owned by the applicant or owner. [None Is this property listed in “The Historic Sites Survey” prepared by Robert Guter 7/9/1992 (1 Yes XI No TAPLANNING.BRD\Document Library|PB-ZBA Application 3-15-13.doc is