TOWN OF HYDE PARK
APPLICATION FOR HEARING BEFORE THE DEVELOPMENT REVIEW BOARD

Tax Map Number:____________________ Permit Number:_______________
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All questions MUST be completed in full or application will be DENIED.
(Please print or type information)

Road Name:____________________________________________________________

Property Owner:_________________________________________________________

Mailing Address:________________________________________________________

Applicant:______________________________________________________________

Mailing Address:________________________________________________________

Telephone Number: Work:_________________ Home:_________________

Engineer of Plan:________________________________________________________

Mailing Address:________________________________________________________

Telephone Number: Work:_________________ Fee: $_______ Paid: Y N

Nature of Request: Conditional Use:________ Variance:_______ Appeal: _____
Site Plan:______ Waiver:_____ Subdivision ____
Description of Project: A site plan must be submitted in duplicate with this application.

Zoning District: RR2_____ RR5_____ OTHER_____________________

Existing Use of Property:_________________________________________________

Proposed Use of Property:________________________________________________

Describe the proposed project:_____________________________________________

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Project Dimensions:_____________________ Lot Size:______________________

Parking Spaces: Required:________________ Planned:______________________

Setbacks: Side:__________, __________ Front:__________Rear:__________

Lot Frontage: ___________ Access Permit: Y N Sewage Permit: Y N

Landscape Plan: Y N Traffic Flow Plan: Y N Light Plan: Y N

The undersigned hereby request an appearance before the Development Review Board for the land development described above. Any permit issued as a result of this application shall be null and void in the event of misrepresentation or failure to complete construction within two years from approval. In order for a permit to issue, the Applicant must be in compliance with ALL Town Ordinances and Town Regulations.

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Signature of Owner Signature of Applicant Date Submitted

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For Administrative Use Only:

Date filed with Administrative Officer:_________________

Date first reviewed by Development Review Board:_____________________________

Notice of Hearing: __________________________

Notice of Surrounding Landowners: ___________________

Date of Hearing(s): ___________________ ____________________
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Date of Decision: ________________ Approved: __________ Denied:________

On the basis of the following findings of facts and conditions attached to the permit, see minutes of: ___________________ ____________________
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Administrative Officer Date

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Chair, Development Review Board Date