ZONING BOARD OF APPEALS CHECKLIST

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ZONING BOARD OF APPEALS CHECKLIST CHECK CONTENTS OF A PETITION FOR A VARIANCE/APPEAL AND/OR SPECIAL PERMIT 1. An ORIGINAL & FOURTEEN (14) copies of the Petition Packet which contains the following: A COMPLETED Petition for Variance, APPEAL and/or Special Permit Application Form. A Certified List of Abutters signed by Assessor. Completed Findings of Fact. 2. A SITE PLAN or Registered Land Surveyors taped Survey showing all dimensions attached to each Application showing abutters, dimensions and relief required. This is subject to the discretion of the ZBA. 3. Two (2) stamped, addressed envelopes for each Party listed on the Certified Abutters list, two (2) stamped addressed envelopes for the petitioner and two (2) stamped envelopes for all planning boards listed on next page. Envelopes must be # 10 size. 4. 14 copies of Assessors map with subject property highlighted. 5. Fee of $300.00 in two checks, one for $150.00 made payable to the Town of Charlton and one for $150.00 made payable to the Worcester Telegram and Gazette. * Please make sure you have included all of the items above so that there will be no delays. If you are missing information your packet will be returned to you until it is complete. Page 1 of 10

Planning Board list of surrounding towns Town of Spencer Town of Southbridge Planning Board Planning Board 157 Main Street 41 Elm Street Spencer, MA 01562 Southbridge, MA 01550 Town of East Brookfield Town of Sturbridge Planning Board Planning Board Memorial Town Complex Center Office Building 122 Connie Mack Drive 301 Main Street East Brookfield, MA 01515 Sturbridge, MA 01566-1078 Town of Leicester Planning Board 3 Washburn Square Leicester, MA 01524 Town of Oxford Planning Board 325 Main Street Oxford, MA 01540 Town of Dudley Dudley Planning Board 71 West Main Street Dudley, MA 01571

IMPORTANT PLEASE NOTE Once a Variance, Special Permit or any extension, modification or renewal thereof is approved, signed and filed with the Town Clerk, the petitioner, after twenty (20) (calendar) days appeal period has expired, must obtain a certified copy of the decision from the Town Clerk s Office (Charlton Municipal Building). Upon obtaining the certified copy of the decision, the petitioner must bring a copy of same to the Worcester District Registry of Deeds, have the decision recorded with the original deed. Your decision is not valid until it has been Recorded and a copy returned to THE ZONING BOARD OF APPEALS Page 2 of 10

EXHIBIT A TOWN OF CHARLTON ZONING BOARD OF APPEALS PETITION The undersigned respectfully petitions the Zoning Board of Appeals for the following: (Choose appropriate request(s) and fill in accordingly) 1. VARIANCES Check for relief A. Dimensional Variance 1. Gross Dimensional Variance Square Footage of proposed relief Square Feet 2. Variance from Side Yard setback Measurement of proposed relief Feet Inches 3. Variance from Frontage requirement Measurement of proposed relief Feet Inches 4. Variance from Rear Yard setback Measurement of proposed relief Feet Inches 5. Variance from Front Yard setback Measurement of proposed relief Feet Inches B. Other Variance 1. What provision of the Zoning Board Bylaw do you want a variance from? Page 3 of 10

2. SPECIAL PERMIT A. For residential use: 1. New residential construction or conversion to additional dwelling units. 2. Number of units proposed. B. For non-residential use: 1. New construction, reconstruction or conversion to non-residential use. 2. Square footage of proposed relief. Square Feet C. Waiver of parking/loading requirements: 1. Number of spaces for which relief is requested Spaces 2. Waiver of landscaping or barrier requirement Square footage of proposed relief. D. Expansion or change of a non-conforming use/structure Square Feet E. Sign/Signs F. Other Special Permit: 1. Describe Special Permit sought 3. ADMINSTRATIVE APPEAL Define what action or decision (attached) you are appealing from and the relief you seek from this Board. 4. AMENDMENT TO EXISTING VARIANCES OR SPECIAL PERMITS 5. EXTENSION OF TIME Page 4 of 10

ALL APPLICANTS: PLEASE COMPLETE QUESTIONS 1 THRU 6 In requesting the above special permit(s), variance(s), appeal, amendment, extension, the undersigned states as follows: (*delete inapplicable terms) 1. That he/she is the owner(s), lessee(s), optionee(s) of certain premises situated at Charlton, Massachusetts. That the record title stands in the name of, whose address(es) is/are, by deed duly recorded in the Worcester District Registry of Deeds, Book(s), Page(s), Assessors Map Lot Block. 2. The property is situated in a district classified under the Town of Charlton Zoning Bylaw as _, 3. Presently located on the property is 4. The petitioner seeks to (Describe what you want to do on the property). 5. Such a use is prohibited under the Town of Charlton Zoning Bylaw under (insert Article, Section(s) and paragraph numbers of the Zoning Bylaw which prohibits the proposed use of the property). Because (Explain how the proposed use violates the Zoning Bylaw). 6. WHEREOF, the petitioner asks that this Board grant the special permit(s), variance(s), appeal(s), amendment(s), extension(s), as requested above. (*delete inapplicable terms). By: (Signature) (Name) (Address) (e-mail) (Telephone) (Date) Page 5 of 10

REQUESTS FOR FINDINGS OF FACT IN SUPPORT OF PETITION FOR A VARIANCE, SPECIAL PERMIT AND/OR APPEALS ALL APPLICANTS: PLEASE COMPLETE QUESTIONS 1 THRU 5 THEN FOLLOW INSTRUCTIONS AT BOTTOM OF PAGE. The Charlton Zoning Board of Appeals having conducted a public hearing and reviewed all the submitted evidence finds that: FINDINGS: 1. The petitioner(s),, whose address is, is/are the owner(s), lessee(s), optionee(s) [*delete inapplicable terms] of certain land situated at in the Town of Charlton and more particularly described in a deed recorded with the Worcester District Registry of Deeds, Book, Page. (If the petitioner is not the owner, complete the following): The owner of said land is, whose address is 2. Said land is situated in a district classified under the Town of Charlton Zoning Bylaw as: 3. Presently located on the premises is 4. The petitioner(s) desire(s) to use said premises as follows: 5. (If applicable) The petitioner(s) duly applied for a building permit to use said site for said purpose but was/were refused for non-compliance with the Zoning Bylaw. FOR A VARIANCE COMPLETE QUESTIONS 6 THRU 10 ON PAGE 6 ONLY FOR A SPECIAL PERMIT COMPLETE QUESTIONS 11 THRU 23 ON PAGES 7,8, & 9 ONLY. Page 6 of 10

FINDINGS OF FACT FOR A VARIANCE ONLY 6. A literal enforcement of the provisions of the Zoning Bylaw would involve substantial hardship, financial or otherwise, to the petitioner(s) for the following reasons: 7. Said substantial hardship is owing to circumstances relating to the soil condition, shape or topography of such land or structures for the following reasons: 8. Said substantial hardship especially affect said land or structures, but does not affect generally the zoning district in which it is located, for the following reasons: 9. Desirable relief may be granted without detriment to the public good for the following reasons: 10. Desirable relief may be granted without nullifying or substantially derogating from the intent or purpose of the Town of Charlton Zoning Bylaw, for the following reasons: STOP HERE FOR VARIANCE APPLICATIONS Page 7 of 10

FINDINGS OF FACT FOR A SPECIAL PERMIT ONLY 11. The proposed use is in harmony with the general purpose and intent of the Town of Charlton Zoning Bylaw for the following reasons: 12. The specific site is an appropriate location for the proposed use for the following reasons: 13. The proposed use as developed will not adversely affect the neighborhood for the following reasons: 14. There will be no nuisance or serious hazard to vehicles or pedestrians for the following reasons: 15. Adequate and appropriate facilities will be provided for the proper operation of the proposed use for the following reasons: _ Page 8 of 10

16. The proposed use will conform to any special requirements provided in Article IV, Section 9, ( Regulatory Provisions for all Districts ) of the Zoning Bylaw. 17. (*Applicable to a request for extensions or alteration of a pre-existing, non-conforming structure or use). The requested change, extension or alteration shall not be substantially more detrimental than the existing non-conforming use to the neighborhood for the following reasons: 18. Grant of the requested Special Permit is authorized by Section of the Town of Charlton Zoning Bylaw. Page 9 of 10

FINDINGS OF FACT FOR A SPECIAL PERMIT ONLY 19. (*Applicable to a request for multi-family residential use in a non-residentially zoned area). The public good would be served by grant of the Special Permit for the following reasons: 20. (*Applicable to a request for multi-family residential use in a non-residentially zoned area). The non-residentially zoned area will not be adversely affected by the requested residential use for the following reasons: 21. (*Applicable to a request for multi-family residential use in a non-residentially zoned area). The permitted use in the non-residentially zoned area is not noxious to a multifamily use for the following reasons: 22. (*Applicable to a proposed accessory use necessary to a permitted use in connection with scientific research or scientific development or related production). The proposed accessory use does not substantially derogate from the public good for the following reasons: 23. (*Applicable to a request for a cluster development). Open land for cluster development shall be conveyed to (*strike out the inappropriate clauses): (*The Town of Charlton for its acceptance for park or open space use). (*, which is a non-profit organization whose principal purpose is the conservation of open space; (*, which is a corporation of trust owned or to be owned by the owners of lots or residential units within the land. Page10 0f 10

APPEALS DATE: Appeal From: SIGNED

REQUEST FORM FOR ABUTTERS LIST FROM ASSESSORS OFFICE Min. $10.00 *5 days notification is required to prepare list. Faxed documents require payment in advance This form is to be completed in full, signed and submitted to the Assessors office to request a Certified Abutters List. Date Requested: Date Needed: Subject Property: Owner Address Assessors ID# Map, Block, Lot Department Requesting List: o Planning Board X Zoning Board of Appeals o Conservation o Board of Selectmen o Zoning Enforcement o Other Requesting Abutters list for: o 100 from subject property o 200 from subject property x 300 from subject property o other: Please specify # of feet: Reason for Abutter List: Date: Signature: o Prepaid o Pick Up o Fax Fax # _ o Mail Address: