1 Application Form

J. VERIFICATION AND AUTHORIZATION 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. I am aware that if any of the foregoing statements are willfully false, | am subject to punishment. Applicant’s Si = a Date:_A\(o|2ZG pp ignature: <<" __ ate ki | 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. Applicant’s Signaturez ae Date: al DI Qo OWNER’S AUTHORIZATION — MUST BE SIGNED I hereby certify that I reside at ~7 5D Easle Cocle Ave West Ormange in the County of Essex and the State of_Afews Serse = ; and 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 123 which property is the subject of the above application, and that said application is hereby authorized by me. Furthermore, | authorize inspection of the site which is the subject of this application. Owner’s signature, 4) _—s Date: a tol Le 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 SS