TEMPORARY CERTIFICATE FOR OUTDOOR DINING AND RETAIL USES
Cit
y of Groton, CONNECTICUT TPZ Permit Number __________
295 Meridian Street Groton CT
860-446-4104
Modification for Existing Outdoor Dining Approval
1. Name of Applicant: _______________________________________
Phone: ___________________________
Mailing Address:
_____________________
______________________________________________________
2. Name of Contact: ______
__________________________________
Phone: ____________________________
Mailing Address:
_____________________
______________________________________________________
Email: ____________
_______________________________________
3. Name of Property Owner: __________________
________________
Phone: ____________________________
Mailing Address:
_____________________
______________________________________________________
4. Property Address:
__________________
_________________________________________________________
5. Assessor’s Lot Number: _____________ 6. Zone
: _____________
Outdoor Dining Approval
Retail
(check one)
7. Provide and attach a list of adjacent property owners (The Town GIS may be used for this
purpose). Plans must be reviewed with respect to potential impact to adjacent property owners.
If deemed appropriate, temporary fencing may be required by staff.
8. TEMPORARY APPROVAL - Any approval granted for new retail or outdoor dining area, or a
modification to existing outdoor dining/retail area is temporary and shall expire upon the
cessation of any Executive Order prohibiting indoor dining/retail. Extension may be requested
with limitations. Certain elements of this approval such as those under the jurisdiction of the
Building Official, Fire Marshal, or Ledge Light Health District, may have conflicting expiration
dates. It is the responsibility of the applicant to renew any lapsing permits with any such
coordinating authorities in the case they expire prior to the suspension of the Executive Order
limiting outdoor dining and retail.
9. By signing this document, I affirm that I have reviewed and agree to adhere to all state executive
orders, rules or guidelines established for this business. The applicant understands that this
application is to be considered complete only when all information and documents outlined under
"Standards and Submissions" have been submitted. In addition, by signing below, the
applicant confirms their understanding of any terms or conditions applied to the permit if
approved, particularly the expiration date. Under no circumstances shall any temporary certificate
be considered a permanent approval, and no permanent rights will vest with the recipient.
Date: _____________
____________________________________________________________
Signature of Applicant/Business owner
Date: _____________
____________________________________________________________
Signature of Property Owner
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