Incorporated

Town of Columbia, N.H.

Application for Zoning Compliance Certificate

Date of this application:_____________________

Name of LANDOWNER:___________________________________________

Mailing address of landowner:_______________________________________________

Name of BUILDING owner if different:__________________________________________

Mailing address of building owner:_____________________________________

Purpose of this application:

_________To erect or place a building.

_________ To erect or place an addition - attached or detached.

_________ to erect or place a sign.

_________to locate a “temporary” (seasonal) camper trailer.

Building site location: fronts what road?__________________tax map ______lot #_______

Lot size:_____________#feet of road frontage_________ depth:____________

Building purpose:(used for)____________________Size___________Exterior finish:________

Foundation type_______________heat type____________chimney type___________

Draw a sketch on reverse side of this sheet to include all abutters and also include the distance from your boundary lines to the proposed building. THIS INFORMATION IS REQUIRED! Incomplete applications will not be processed!

Is this property located within the FLOOD ZONE?________

Are there covenants (restrictions) stated in the deed to this property?_______________________

Does water and sewer meet State of NH requirements? ______yes _____no_____

If residential, provide us your NH sewerage disposal Permit Number______________________

What type of road is this property located on? Approved subdivision road?_____Class VI?____

Class V?______other?____________

Driveway approved by? State_______Town?_____no zoning compliance certificates will be issued without verification of approved driveway installations.

The undersigned declares the above information is correct and complete and the proposed work shall be completed in accordance with all of the Town of Columbia Ordinances and State of NH requirements.

Signature(s) of proposed building applicant. __________________________________________

______________________________________________________________________________

Signature(s) of LANDOWNER(S)_________________________________________________

All approved certificates must be posted at construction site. Certificates expire in ONE year. Remember: It is YOUR RESPONSIBILITY to call DIG SAFE BEFORE digging!! It is YOUR RESPONSIBILITY to return the certificate/or a completion report or call and let the Planning Board know when building project is completed.

Below lines for Planning Board Use Only.

****************************************************************************************

Application #____________ Fee Paid- $____________   how?___________:

granted date_________refused date_______revoked date________renewed date________

Any other additional relevant information:

3/13/13