Revised August 3, 2010 1
CITY OF DANBURY
155 DEER HILL AVENUE
DANBURY, CONNECTICUT 06810
ZONING BOARD OF APPEALS
(203) 797-4525
(203) 797-4586 (FAX)
APPLICATION FOR A
CERTIFICATE OF LOCATION APPROVAL
An “Application for a Certificate of Location Approval” shall be submitted to the Zoning Board of Appeals
to engage in the sale of gasoline or any other product under the provisions of Chapter 250 Section 14-321 of
the Connecticut General Statutes (“CGS”), as amended. Such Certificate of Location Approval is a
prerequisite to obtaining a license to operate said use from the Commissioner of the State of Connecticut
Department of Consumer Protection.
This “Application” form shall be completed and signed by the property owner and
the applicant/agent and
shall be accompanied by all documents, plans, fees and other materials specified below under
“Submission Requirements.” Failure to comply with all “Submission Requirements” may result in a denial
of the Application.
______________________________________________________________________________________
Please check:
Sale of Gasoline or any other product under the provisions of Chapter 250 Section 14-319 of the CGS.
___________________________________________________________________________________
1. Business Name _________________________________________________________________
2. Street address of the proposed development: _____________________________________________
3. Date submitted: ____________________________________________________________________
4. Property owner’s name: ____________________________________ Phone: __________________
Address: _________________________________________________ Fax: ____________________
(street, city, state, zip code)
5. Applicant/Agent’s name: ____________________________________ Phone: _________________
Address: __________________________________________________Fax: ___________________
(street, city, state, zip code)
6. Interest in property (Check One)
Owner Developer Option Holder Other (describe) ____________________
