Application No. ______________________                     Filed: ________________________
                                                                                          _____________________________
                                                                                                                           Board Secretary

APPLICATION FOR SITE PLAN APPROVAL

PLANNING BOARD

BOROUGH OF MADISON

This application must be filed twenty-one (21) days prior to date of hearing.

TO THE PLANNING BOARD:

1. Applicant: _________________________________________________________________
                                            (Name)                                                                                                           (Telephone Number)
   _________________________________________________________________________
                                                                           (Address)
    
2. Attorney: _________________________________________________________________
                                           (Name)                                                                                                          (Telephone Number)
   _________________________________________________________________________
                                                                           (Address)
    
3. Engineer: _________________________________________________________________
                                            (Name)                                                                                                          (Telephone Number)
   _________________________________________________________________________
                                                                           (Address)
    
4. Architect: _________________________________________________________________
                                            (Name)                                                                                                           (Telephone Number)
   _________________________________________________________________________
                                                                           (Address)
    
5. Proposed improvements to be made or the proposed use of land.

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

6. Location of property: __________________________________________________________
                                                  (No.)                            (Street)

Lot: __________ Block: ____________ Zone: ___________Size of Property:____________

7. The applicant is the owner of the property involved. If applicant is other than the owner, state the basis on which the application is made, i.e., Purchaser under Contract with the owner, or as the case may be, AND, owners must sign consent and authorization at end of application.
    
8. The section(s) of the Zoning Ordinance requiring site plan approval by the Planning Board is/are:

___________________________________________________________________________

    Applicant furnishes herewith twenty-one (21) copies of a site plan, certified by a professional engineer or land surveyor of the State of New Jersey, which complies in all respects with the requirements of the Zoning Ordinance.

I certify that all of the above statements and the information contained in all exhibits submitted herewith are true.

                                                                                      _______________________________________
                                                                                                                    (Applicant's Signature)

                                                                                       _______________________________________
                                                                                        (Address)

Dated:________________________________.

(If applicant is not owner of premises, owner(s) must sign this consent.)

        The undersigned, owner(s) of the premises in paragraph 6, supra, consent(s) to the foregoing application and agree(s) to be bound by the action taken thereon.

                                                                                    _______________________________________

                                                                                    _______________________________________
                                                                                                                (Signature of Owner(s))                                                                                     _______________________________________
                                                                                    (Address)

Dated: ________________________________.