TOWN OF BURGAW
ZONING COMPLIANCE PERMIT APPLICATON
Date:_________________
APPLICANT INFORMATION
Name: _____________________________________________________ Phone: ________________________
Address: ___________________________________________________________________________________
Email Address:______________________________________________________________________________
PROPERTY ADDRESS
Location: ___________________________________________________________________________________
Owner: _____________________________________________________________________________________
NEW USE OR CHANGE OF USE
Proposed Use (please list all proposed and potential uses): Home Occupation
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NEW ACCESSORY AND PRIMARY STRUCTURES
New Construction of Building Storage Shed/Accessory Building
Addition/Alteration of Existing Building Deck/Porch Additions
Fence Garage/Carport
Swimming Pool
Other (please explain) _______________________________________________________________
For New Accessory and Primary Structures:
Structure Size ___________________________ Height______________________
Permanent Foundation Yes No
Closest Distance from Property
Line to Structure (in feet) _____Front _____Side ______Back
With this Zoning Compliance Permit Application, please include a site plan or drawing showing
the following information.
All existing buildings and structures
Number and location of parking spaces, if applicable
Driveways
Location and distance from property lines for proposed structures
Other Information may be required.
I attest that all information above and attached plan(s) are accurate and correct to the best of
my knowledge.
SIGNATURE OF APPLICANT: _________________________________________ DATE: _____________
OFFICE USE ONLY:
Application received by: ________________________________________________________ Date: _______________
Permit issued by: ______________________________________________________________ Date: _______________
Permit Refused by: ____________________________________________________________ Date: -----------------------
PIN: _ _ _ _ - _ _ - _ _ _ _ - _ _ _ _
Applicant Name: _________________________________________________________________
Location: _______________________________________________________________________
Owner: _________________________________________________________________________
PIN: ____________________________________________________________________________
Requested Use(s): _________________________________________________________________
Owner’s Statements & Signatures
[Required if applicant is not property owner]: In filing this application for a zoning permit, I/we, as the
property owner(s), hereby certify that all of the information presented in this application is accurate to
the best of my knowledge and belief. I hereby authorize the applicant to submit an application affecting
the use of my property. I/We understand that the issuance of this permit will override any previous
permits and grandfathered uses, including Conditional Use Permits that may have been issued for my
property.
Signature of Owner(s): Date:
[Required if owner wishes to establish an agent (attorney, real estate agent, etc.)]: I/we hereby
designate _________________________________________ to act on my behalf regarding this
application, to receive and respond to administrative comments, to resubmit plans on my behalf, and to
speak for me in any public meeting regarding this application.
Signature of Owner(s): Date:
TOWN OF BURGAW
ZONING COMPLIANCE PERMIT
PROPERTY OWNER STATEMENT
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