Town of Strasburg

Zoning Permit

(Revised 5/01/06)

Application is hereby made for a Zoning Permit in accordance with the description and the purpose hereinafter set forth.  This application is made subject to all local and state laws and ordinances and which are hereby agreed to by the undersigned and which shall be deemed a condition entering into the exercise of this permit.

1)  Owners Name                                                                                                 

2)  Date                                                                                                           

3)  Owners Mailing Address                                                                             

4)  Telephone numbers                                                                                        

5)  Size of Parcel                                                                                            

6)  If purchased in last two years, give previous owners name                                                              

 7)  Location of Property, Street                                                                      

 8)  The purpose of this permit: ( ) Building  ( ) Enlarge  ( ) Remodel  ( ) Fence  ( ) Other __________

 9)  If for alterations or repairs, state nature                                                                                                                                                              

10) Use of structure                              11) Size of Structure              

12) No. of other dwellings on parcel                    13) No. of other structures on parcel                                                                                                             

14) Building setbacks: Front                         Side                        Side                        Rear                       

15)  Height of structure                                                                                      

16)  Completion Date                                                                                        

I hereby certify that I have the authority to make the foregoing application, that the information given is correct and that the construction will conform with the regulations in the building code, zoning ordinances and private building restrictions, if any, which may be imposed upon the above property by deed.  I, further, hereby covenant to restore any and all damages to sidewalks, streets, alleys, sewers, gas mains, water mains, electric installations which may result.

Signature of owner                                                                                            or

Authorized Agent                                                                                             

Telephone Number                                                                                           

Real Estate Taxes Paid    ( ) Yes     ( )  No                     Amount owed  $           

Tax Map Designation                                          Zoning                                   

Approved                                    Disapproved                                          Flood Plain                            

Zoning Administrator                                                                              

Date                                        

Comment