TOWN OF NEWTON
APPLICATION TO APPEAR BEFORE
THE NEWTON UTILITY ADVISORY BOARD

Section 1.

Name of Applicant: *

Mailing Address:*

Property Address:*

Telephone Number: (include area code)*

Email:

Nature of Request (Describe in Detail):*

Section 2.

Engineer, Surveyor, Building Contractor or Plumbing Contractor Only:

Name: *

License No.:

Mailing Address:*

Telephone Number: (include area code)*

Email:

Proposed Request is For: (check all that apply)*

Residentail Use Industrial Use Individual Lot

Commercial Use Tract Development Other (Please explain below)

If Other Explain Below

Section 3.

Name of property Owner:

Property Location(street address, block and lot numbers):*

Site Plan Approval

Yes

No

Approval Obtained From:

Planning Board

Zoning Board of Adjustment

Date:*

Signature of Applicant:*

Please complete the information above, print and submit this form to the Utility Collector in the Finance office.