File # ___________
Map ___ Lot _____
Date filed________
Fees paid ________
Escrowed funds _______
____________________
(signed)
PLANNING BOARD APPLICATION
1. Applicants’ Name(s):___________________________________________________
Address: ___________________________________________________
Signature(s) _________________________________________ Tel #: ___________
*(Letter of authorization to be provided if plan presented by other than applicant.)
2. Land Owner of Record’s Name: __________________________________________
Address: ___________________________________________________
Signature(s) _________________________________________ Tel #: ___________
*(Letter of authorization to be provided if plan presented by other than applicant.)
3. Location of Parcel (street, lane, route): ____________________________________
Size of Entire Parcel: ________________ Tax Map & Lot #: ______________
4. Proposal for Parcel:
______ A. Subdivision – Number of Lots ____________
______ B. Site Plan Review for:
______ Multi-family Residential – Number of Units: _______
______ Commercial – Number of Square Feet: ____________
______ Industrial – Number of Square Feet: ______________
______ Home Occupation for __________________________________
______ C. Boundary Line Adjustment
______ D. Other (explain): ______________________________________________
5. Names and Addresses of any engineer, architect, land surveyor or soil scientist whose professional seal appears on the plat.
6. Holders of Conservation, Preservation or Agricultural Preservation restrictions per RSA 477:45.
The Applicant is responsible for supplying the names and addresses of all *abutters to the property concerned including the names and addresses of any Engineer, Architect, Land Surveyor or Soil Scientist whose professional seal appears on the plat and holders of Conservation, Preservation or Agricultural Preservation Restrictions per RSA 477:45.
*For purposes of Notification: RSA 672:3-“Abutter” means any person whose property is located in NH and adjoins or is directly across the street or stream from the land under consideration…
The Applicant is to include addressed envelopes with addressed postal certification slips for each of the parties to be notified.
Please List Current Abutters For Legal Notification Purposes:
Name Address Zip Code Map# Lot#
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______________________________________ ____________
Signature of Applicant Date