Planning Board Meeting Request

TOWN OF DURHAM, MAINE PLANNING BOARD REQUEST FOR MEETING

NAME OF APPLICANT:                                                   PHONE #:
EMAIL:                                                           ALT. PHONE#:
FULL ADDRESS:
PROPERTY ADDRESS:
MAP:           LOT:

AGENT/REPRESENTATIVE (if other): PHONE #:

EMAIL: FULL ADDRESS:

The undersigned requests the Durham Planning Board consider the following application for:

Conditional Use                                                          Amended Subdivision
Subdivision                                                              Amended Conditional Use
Site Plan Review                                                         Amended Site Plan
Other (Specify):

NOTE TO APPLICANT:

1. This form and 10 printed copies of the application and supporting materials must be filed at the Town Offices no later than (fourteen) 14 days prior to the regular meeting of the Board (first Wednesday monthly). Applications shall be accompanied by all applications fee and materials required by the Select Board's fee schedule. A digital version of all materials must be sent to the Town Planner at townplanner@durhammaine.gov for public posting.

2. All applications shall include all materials and copies as specified on the applications and checklists (conditional use, subdivision, & site plan).

3. All materials in color shall be copied in color. Application Authorization I hereby make application to the Town of Durham for the above-referenced property(ies) and the development as described. To the best of my knowledge, the information provided herein is accurate and is in accordance with the Land Use Ordinances of the Town, except where waivers are requested. The Durham Planning Board and/or Town employees are authorized to enter the property for purposes of reviewing this proposal and for inspecting improvements as a result of an approval of this proposal. I understand that I am responsible for appearing, or having someone appear on my behalf, at all meetings before the Planning Board. Signature: Date: Printed Name:

Please identify yourself (check one):   Agent*:           Property Owner:

630 HOLLOWELL ROAD, DURHAM, MAINE 04222 PHONE: (207) 353-2561 * FAX: (207) 353-5367

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