Completed revised application form

T:\PLANNING.BRD\Document Library\PB-ZBA Application 3-15-18.doc 1/5 TOWNSHIP OF WEST ORANGE APPLICATION FORM FOR THE PLANNING BOARD OR ZONING BOARD OF ADJUSTMENT A. APPLICANT INFORMATION B. PROPERTY OWNER INFORMATION C. PROPERTY INFORMATION Full Legal Name: Crestmont Country Club, Inc.__________________________________________________ _________ (Last) (First) Mailing Address: 750 Eagle Rock Avenue____________________________________________________________ ___ West Orange NJ 07052(Street) (City) (State) (Zip) Telephone Number: ( ) )Email:____________________________________ Is the Applicant an: Individual, Corporation, Partnership Other _________________________ 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: XOwner, 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. Check here if same as applicant. If the owner is not the applicant, please complete the following: ___________________________________________________________ Address: ________________________________________________ Telephone Number: ( ) ___________ ______________Email:_____________________________________ Street Address: 750 Eagle Rock Avenue________________________________________ ______ Block Number (s):74 __________________________; Lot Number (s): __________________________; Tax Plate: _____________________________; 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? Yes, Date(s): _________________________________________________________________; No 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. None Yes No 1 1.01 973 232-5061

h 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. None Yes No 1 1.01 973 232-5061 (attorney rick@schkolnicklaw.com Same as applicant X See attached resolutions of approval x X - 501C7 ** Not for ProfitX 121