1 Application Form

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 (State NJ (zip) 07052 Telephone Number: (973 ) 232-5061 - attorney Email:_rick@schkolnicklaw.com - attorney Is the Applicant an: C1 Individual, XI Corporation, (1 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. Relationship of the applicant to the property: [{ Owner, [] Tenant or Lessee, 0 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: 790 Eagle Rock Avenue Block Number(s): 174 ; Lot Number(s): 1.01 Tax Plate:_123 ; Zone of Property: _R-2 Zone The location of the property is approximately Ofeet feet from the intersection of Laurel Avenue site is located at the intersection of Eagke Rock Avenue and Laurel Avenue (closest intersection.) Has there been any previous Zoning Board of Adjustment or Planning Board hearings involving this property? A Yes, Date(s): See attached resolutions of approval for pickleball and modular dwelling; O 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 Is this property listed in “The Historic Sites Survey” prepared by Robert Guter 7/9/1992 [1 Yes KI No TAPLANNING.BRD\Document Library\PB-ZBA Application 3-15-18.doc us