PB 24 13 IMMC Health Complete Application

TOWNSHIP OF WEST ORANGE APPLICATION FORM FOR THE PLANNING BOARD OR ZONING BOARD OF ADJUSTMENT A. APPLICANT INFORMATION Full Legal Name: _ Elion Krok MD PC dba IMMC Health/CACS t) First) Mailing Address: 993 Pleasant Valley Way, West Ofange, New Jersey 07052 (Street) (City) (State) (Zip) “.. Telephone Number: (973) 544-8901 Erail:___imme993@gmail.com™ Is the Applicant an: 0) Individual, (J Corporation, ) Partnership, 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, (] Tenant or Lessee, CJ 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 "SK check here if same as applicant, Lf the owner is not the applicant, please complete the following: Elion Krok MD PC dba IMMC Health/CACS se Owner's Name: * " Address:993 Pleasant Valley Way, West Orange, New Jersey 07052 Telephone Number: (973 __ 544-8901 Email; _ immce993@gmail.com C. PROPERTY INFORMATION Street Address: _993 Pleasant Valley Way, West Orange, New Jersey 07052 Block Number(s): 172.02 ; Lot Number(s): 6 _ Tax Plate: 3 Zone of Property:_B-2 The location of the property is approximately feet from the intersection of. and. (closest intersection.) * Has there been any previous Zoning Board of Adjustment or Planning Board hearings involving this property? . SX Yes, Date(s): Resolution PB 22-04, adopted 08/03/2022 :ONo * “IEyes, please attach copies of the written decisions adopted by the Board to each application See attached. ‘Please attach a list of all contiguous or adjacent property owned by the applicant or owner. SX None (5 this property listed in “The Historic Sites Survey" prepared by Robert Guter 7/9/1992 1] Yes BXNo THPLANNENGARDWDncument Librars|PB-ZBA Application J-20-[5.ulye