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									                                  CITY OF NEWARK
                             ( ) BOARD OF ADJUSTMENT
                           ( ) CENTRAL PLANNING BOARD
                                  APPLICATION FOR
    ( ) PRELIMINARY SITE PLAN    ( ) FINAL SITE PLAN      ( ) MINOR SITE PLAN
                  ( ) MAJOR SUBDIVISION ( ) MINOR SUBDIVISION
           ( ) CONDITIONAL USE ( ) C VARIANCE       ( ) D VARIANCE


APPLICATION NO. ____________

DATE FILED ____________, 20___                   HEARING DATE __________, 20 __


                                          SECTION A

APPLICATION IS HEREBY MADE FOR APPROVAL OF SITE PLAN FOR LAND
DEVELOPMENT AS HEREIN DESCRIBED AND SHOWN ON THE ACCOMPANYING MAPS IN
ACCORDANCE WITH THE SITE PLAN ORDINANCE OF THE CITY OF NEWARK.

PREMISES

NAME OF PROJECT: _________________________________________________________________________

ADDRESS: ___________________________________________________________________________________

BLOCK(S): ___________________________________    LOT(S): ___________________________________

WARD: _____________________ ZONE: __________________________ HISTORIC DISTRICT ( ) YES ( ) NO

PRESENT USE / CONDITION:_________________________________________________________________

PROPOSED USE: _____________________________________________________________________________




OWNER: ___________________________________________________________________________________
                                          Name (print or type)

ADDRESS: ___________________________________________________________________________________

PHONE #: ___________________________________      FAX#:____________________________________

EMAIL:______________________________________
                                                        ____________________________________
                                                        Owner’s Signature
IF APPLICANT IS OTHER THAN OWNER:


I HEREBY AUTHORIZE _______________________________________________________________________
                                     Name (print or type)

ADDRESS: ___________________________________________________________________________________

PHONE #: ________________________________        FAX#:____________________________________

EMAIL:___________________________________

TO ACT AS MY AGENT IN PROCESSING THIS APPLICATION.
                                                        ___________________________________
                                                        Owner’s Signature



ARCHITECT/ ENGINEERING FIRM: _______________________________________________________

NAME OF ARCHITECT/ENGINEER: ___________________________________________________________

ADDRESS: __________________________________________________________________________________

PHONE #: ________________________________        FAX#:____________________________________

EMAIL:___________________________________        LICENSE # ________________________________



ATTORNEY/ FIRM: _______________________________________________________________________________

NAME OF ATTORNEY: ___________________________________________________________________________

ADDRESS: ______________________________________________________________________________________

PHONE #: _________________________________       FAX#:________________________________________

EMAIL:____________________________________



PROJECT DESCRIPTION
LOT AREA: ___________________________________    GROSS FLOOR AREA: ______________________________
NET FLOOR AREA: ___________________________      PROJECT FLOOR AREA: ___________________________
APPROX. NO. EMPLOYEES: ___________________       HOURS OF OPERATION: ___________________________
NUMBER OF PARKING SPACES: _______________        GROUND FLOOR AREA: ____________________________
LANDSCAPE AREA: ___________________________      PARKING AREA: ___________________________________
CIRCULATION AREA: _________________________      NUMBER OF HOUSING UNITS: ______________________




                                                                                                2
                                      IS THIS APPLICATION A RESULT OF:
      ( ) NEW APPLICATION        ( ) REVISED OR RESUBMISSION OF A PRIOR APPLICATION
                        ( ) A ZONING VARIANCE      ( ) A SUBDIVISION

                                        IF REVISION OR RESUBMISSION:

Date: ___________, 20____ ( ) APPROVED ( ) DENIED BY ( ) CENTRAL PLANNING ( ) BD OF ADJ


                                            FOR OFFICIAL USE ONLY


RECEIVED THIS ________DAY OF ___________________, 20__ FOR SITE PLAN REVIEW ACCORDING
TO THE SITE PLAN SUBMITTAL REQUIREMENTS AND REQUISITE FEE OF $___________________

                                                              ______________________________
                                                              Signature of Planning Board Official



                                                  SECTION B
APPLICATION IS HEREBY MADE FOR APPROVAL OF THE SUBDIVISION OF LAND AS
HERIN DESCRIBED AND SHOWN ON THE ACCOMPANYING PLAT IN ACCORDANCE WITH
THE SUBDIVISION ORDINANCE OF THE CITY OF NEWARK.

ACREAGE OF TRACT TO BE SUBDIVIDED: _______________NUMBER OF LOTS PROPOSED: __________
IS THE SUBJECT PROPERTY LOCATED ON A COUNTY ROAD? ( ) YES ( ) NO;
STATE ROAD? ( )YES ( ) NO; OR WITHIN 200 FEET OF A MUNICIPAL BOUNDARY? ( ) YES ( ) NO
WAS THE PROPERTY SUBJECT TO A PRIOR SUBDIVISION? ( ) YES ( ) NO (If so, list dates of prior
subdivision and attach a resolution or minutes)
ARE THERE ANY EXISTING OR PROPOSED DEED RESTRICTIONS, EASEMENTS, RIGHT-OFWAY OR
OTHER DEDICATION? ( ) YES ( ) NO (If yes, attach a copy)

THE DEED OR PA PLAT MUST BE FILED WITH THE COUNTY RECORDING OFFICER, THE MUNICIPAL
ENGINEER, AND THE MUNICIPAL TAX ASSESSOR WITHIN 190 DAYS.


                                            FOR OFFICIAL USE ONLY


RECEIVED THIS ________DAY OF ___________________, 20__ FOR SUBDIVISION ACCORDING TO THE

SUBDIVISION SUBMITTAL REQUIREMENTS AND REQUISITE FEE OF $________________________.


                                                              ______________________________
                                                              Signature of Planning Board Official



                                                                                                     3
                                                  SECTION C


APPLICATION IS HEREBY MADE FOR CONDITIONAL USE AND/OR VARIANCE FROM THE
TERMS OF THE ZONING ORDINANCE OF THE CITY OF NEWARK.

An appeal is hereby made for ( ) Conditional Use ( ) Variance from the terms of Section (s) _______________of the
Zoning Ordinance, so as to permit: ____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________



                                           FOR OFFICIAL USE ONLY

RECEIVED THIS ________DAY OF ___________________, 20__ FOR VARIANCE/CONDITIONAL USE
ACCORDING TO THE VARIANCE/CONDITIONAL USE SUBMITTAL REQUIREMENTS AND REQUISITE
FEE OF $________________________.

                                                                     ______________________________
                                                                     Signature of Zoning Official



SIGN – OFF APPROVAL BY CENTRAL PLANNING BOARD FOR APPLICATION TO GO FORWARD WITH


RESPECT TO SITE PLAN REVIEW: ___________________________________________________________


DATE: __________________ 20____

                                                          ________________________________________
                                                           Supervising Planner Land Development Review




ZONING DISTRICT: ______________________________________


DATE: ___________________ 20 ____

                                                           ________________________________________
                                                           Zoning Officer




                                                                                                                4
                                                   SECTION D


CERTIFICATION BY TAX COLLECTOR
(No application will be deemed complete unless this section has been signed by the tax collector)

BLOCK(s)__________________________ LOT(s)______________

     ( ) There are no taxes due.
     ( ) There are taxes due and arrangements have been made to pay them.
     ( ) There are taxes due and no arrangements have not been made to pay them.

________________________                                                 __________________________________
 DATE                                                                         TAX COLLECTOR’S SIGNATURE




                                       AFFIDAVIT APPLICATION

STATE OF NEW JERSEY
COUNTY OF ESSEX

_______________________________________________of full age, being duly sworn according to law, on oath,
deposes and says that all of the above statements and the statements contained in the papers submitted herewith
area true.
Sworn to and subscribed before me this __________________day of______________, 20____.



                                                                       _______________________________________
                                                                             APPLICANT’S SIGNATURE




                                      AFFIDAVIT OF OWNERSHIP

STATE OF NEW JERSEY
COUNTY OF ESSEX


_______________________________________________of full age, being duly sworn to law on oath, deposes and
says, that despondent resides at_________________________________________ in the City of______________, in
the County of____________________ is the owner in fee of all that certain lot, piece of parcel of land situated, lying
and being in the City of Newark aforesaid, known and designated as ________________________________________
________________________________________________________________________________________________.
Sworn to and subscribed before me this __________________day of______________, 20____.


                                                                        ______________________________________
                                                                              OWNER’S SIGNATURE


                                                                                                                     5
                                 ZONING DETERMINATION FORM

                   THE FOLLOWING INFORMATION HAS BEEN FILED WITH THE
    ( ) CENTRAL PLANNING BOARD ( ) ZONING BOARD OF ADJUSTMENT IN CONJUNCTION WITH AN
                                     APPLICATION FOR

( ) S I TE PL AN ( ) S U B DIV IS IO N ( ) COND I TI ONA L U SE ( ) C V A RI ANCE ( ) D VA RI AN CE

PREMISES (Street Address & Number / Block(s) and Lot Number(s):_______________________________________

_________________________________________________________________________________________________
ALL PRESENT USES OF PROPERTY: ________________________________________________________________
___________________ _____________________________________________________________________________
SIZE AND TYPE OF EXISTING BUILDINGS: __________________________________________________________
_________________________________________________________________________________________________
SIZE AND TYPE OF PROPOSED BUILDINGS: _________________________________________________________
_________________________________________________________________________________________________
EXPLANATION OF PROPOSED PROJECT: ____________________________________________________________
_________________________________________________________________________________________________
HOURS OF OPERATION:_______________________ NO. (#) OF EMPLOYEES____________________________
APPLICANT’S NAME:____________________________________PHONE NO._______________________________
ADDRESS:_______________________________________________________________________________________
OWNER’S NAME:______________________________________PHONE NO._________________________________
ADDRESS:_______________________________________________________________________________________
SIGNATURE OF APPLICANT_______________________________________________________________________




                                             FOR OFFICIAL USE ONLY

ZONING DISTRICT:____________________________________________________________________________

DETERMINATION:_____________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
            This property ( ) is ( ) is not designated as a Historic Site or located in a Historic District.


_______________________                                                ___________________________________
       Date                                                                          Zoning Officer


                                                                                                               6
                                         DISCLOSURE STATEMENT
                                             TO BE USED BY
                           ( ) PROFIT CORPORATION ( ) NON PROFIT CORPORATION


Name of Corporation
or Partnership____________________________________________________________________________
Principal Place of Business___________________________________________________________________
________________________________________________________________________________________
Name of Registered Agent___________________________________________________________________
Address_________________________________________________________________________________
Incorporated in State of_____________________________________________________________________


NAME                               ADDRESS                                      PERCENT OWNED (%)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
I certify that the above represents the name(s) and address(es) of all stock holders or partners of a 10% or greater
interest in the above corporation or partnership. If one or more of the above is itself a corporation or partnership. I
have annexed hereto the names and addresses of anyone who owes a 10% or greater interest therein.


I certify that the foregoing statements made by me are true. I am aware that if any of the going statements made by
me are willfully false, I am subject to punishment.
Date:________________________


Signature_______________________________________________


_________________________________
Name of Person Signing
(Type or Print)


________________________________
Title of Person Signing


        WHERE APPLICABLE, KINDLY INCLUDE A COPY OF THE CERTIFICATE OF INCORPORATION
                                                         DisClos




                                                                                                                          7
                              BOARD OF ADJUSTMENT
                      NOTICE OF HEARING TO PROPERTY OWNERS
                                   Form of Notice

Calendar # ___________        Filed __________       Date: __________

To ____________________________Owner of Premises ________________________.

Please take notice that the undersigned has appealed to the Board of Adjustment of the City of
Newark for a Variance from the terms of the Zoning Ordinance so as to permit on premises (add
address and Block and Lot):
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________ ,

which is within 200 feet of property owned or resided by you. Any person or persons affected by this
application may have an opportunity to be heard at the Public Hearing of _____________20____, at
7:00 P.M., and thereafter on such other dates as such hearing may be continued, in the Municipal
Council Chamber, 2nd Floor, City Hall, 920 Broad Street, Newark, New Jersey 07102 at which time
you may appear either in person, by agent or by attorney and present any objections which you may
have to granting this Variance.

All documents relating to this application may be inspected by the Public between the hours of 8:30
A.M. and 4:30 P.M. in the Office of Boards, City Hall, Room 112, 920 Broad Street, Newark, New
Jersey 07102.

The applicant, by order of the Board of Adjustment, sends this notice to you.

Respectfully,



________________________
Applicant

THIS NOTICE MUST BE PERSONALLY SERVED OR SENT BY CERTIFIED MAIL AT
LEAST TEN (10) DAYS PRIOR TO THE DATE OF THE HEARING AND PROOF OF
SERVICE MUST BE SUBMITTED TO THE BOARD OF ADJUSTMENT TWO (2) DAYS
PRIOR TO HEARING OR CASE WILL NOT BE HEARD.




                                                                                                  8
                                   BOARD OF ADJUSTMENT
                                     NOTICE OF HEARING
                                   Form of Notice for Newspaper


Calendar # ___________        Filed __________       Date: __________


Please take notice that the undersigned has appealed to the Board of Adjustment of the City of
Newark for a Variance from the terms of the Zoning Ordinance so as to permit on premises (Add
address and Block and Lot):
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________ .

Any person or persons affected by this application may have an opportunity to be heard at the Public
Hearing of _____________20____, at 7:00 P.M., and thereafter on such other dates as such hearing
may be continued, in the Municipal Council Chamber, 2nd Floor, City Hall, 920 Broad Street,
Newark, New Jersey 07102 at which time you may appear either in person, by agent or by attorney
and present any objections which you may have to granting this Variance.

All documents relating to this application may be inspected by the Public between the hours of 8:30
A.M. and 4:30 P.M. in the Office of Boards, City Hall, Room 112, 920 Broad Street, Newark, New
Jersey 07102.

The applicant, by order of the Board of Adjustment, sends this notice to you.

Respectfully,



________________________
Applicant

THIS NOTICE MUST BE PUBLISHED IN A NEWSPAPER OF GENERAL
CIRCULATION IN THE CITY OF NEWARK, NEW JERSEY AT LEAST TEN (10) DAYS
PRIOR TO THE DATE OF THE HEARING AND PROOF OF SERVICE MUST BE
SUBMITTED TO THE BOARD OF ADJUSTMENT TWO (2) DAYS PRIOR TO HEARING
OR CASE WILL BE NOT HEARD.




                                                                                                  9
                              AFFIDAVIT OF PROOF OF SERVICE

                                  BOARD OF ADJUSTMENT
                               CITY OF NEWARK, NEW JERSEY

Calendar No# ______________                                   Filed ___________________

PROOF OF SERVICE OF NOTICES REQUIRED BY STATUTE OR ORDINANCE MUST
BE FILED AND VERFIED WITH THE BOARD SECRETARY AT LEAST TWO (2) DAYS
PRIOR TO THE HEARING OR CASE WILL NOT BE HEARD.

STATE OF NEW JERSEY)
                   ) S.S.
COUNTY OF ESSEX    )

______________________________________of full age, being duly sworn according to law,
deposes and says, that she ( ) he ( ) resides at _______________________________
In the municipality of _________________________County of ____________________
and State of _______________________: that _______________________________is the appellant
in a proceeding before the Board of Adjustment, City of Newark, being an appeal under the Zoning
Ordinance,    and   which    has   the   Calendar    No____________,       and   relates   to   premises
____________________________, Newark, NJ that on or before _________________ 20____,
which is at least 10 days prior to the date of hearing, he/she gave written notice of the hearing on this
appeal to each and all of the owners of property affected by said appeal, in the form hereinafter set
forth, and according to the attached lists, and in the manner indicated therein and posted such notice
in a prominent place in a lobby or hall of all residential properties of more than four units; and the
notice published in an official newspaper of general circulation in the City of Newark.

A copy of said notices are attached hereto as Exhibit “B”.

Respectfully,
_________________________
Applicant
Sworn to before me, this _______day of _______________20____.

                                                      ______________________________
                                                      (To be signed here by person who
                                                      served the notices)
__________________________________
A Notary Public of the State of New Jersey

                                                                                                      10
                       NEWARK CENTRAL PLANNING BOARD
                     NOTICE OF HEARING TO PROPERTY OWNERS

                                          Form of Notice

Application # ___________ Filed __________          Date: __________

To ____________________________Owner of Premises ________________________.

Please take notice that the undersigned has applied to the Central Planning Board of the City of
Newark for a (Type of Application) at premises (Add address and Tax Block and lot) in order to
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________ ,

which is within 200 feet of property owned or resided by you. Any person or persons affected by this
application may have an opportunity to be heard at the Public Hearing of the Central Planning Board
on _____________20____, at 6:30 P.M., and thereafter on such other dates as such hearing may be
continued, in the Municipal Council Chamber, 2nd Floor, City Hall, 920 Broad Street, Newark, New
Jersey 07102 at which time you may appear either in person, by agent or by attorney and present any
comments which you may have regarding this application.

All documents relating to this application may be inspected by the Public between the hours of 8:30
A.M. and 4:30 P.M. in the Office of Boards, City Hall, Room 112, 920 Broad Street, Newark, New
Jersey 07102.


Respectfully,



________________________
Applicant


NOTE: THIS NOTICE MUST BE PERSONALLY SERVED OR SENT BY CERTIFIED OR
REGISTERD MAIL AT LEAST TEN (10) DAYS PRIOR TO THE DATE OF HEARING
AND PROOF OF SERVICE MUST BE GIVEN TO THE CENTRAL PLANNING BOARD
AT LEAST TWO DAYS BEFORE THE HEARING.




                                                                                                 11
                          NEWARK CENTRAL PLANNING BOARD
                          NOTICE OF HEARING (FOR NEWSPAPER)

Application # ___________ Filed __________          Date: __________

To ____________________________Owner of Premises ________________________.

Please take notice that the undersigned has applied to the Central Planning Board of the City of
Newark for a (Type of Application) at premises (Add address and Tax Block and lot) in order to
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________ .

Any person or persons affected by this application may have an opportunity to be heard at the Public
Hearing of the Central Planning Board on _____________20____, at 6:30 P.M., and thereafter on
such other dates as such hearing may be continued, in the Municipal Council Chamber, 2nd Floor,
City Hall, 920 Broad Street, Newark, New Jersey 07102 at which time you may appear either in
person, by agent or by attorney and present any comments which you may have regarding this
application.

All documents relating to this application may be inspected by the Public between the hours of 8:30
A.M. and 4:30 P.M. in the Office of Boards, City Hall, Room 112, 920 Broad Street, Newark, New
Jersey 07102.


Respectfully,



________________________
Applicant



Applicant




                                                                                                 12
                                        AFFIDAVIT OF PROOF OF SERVICE

                                     NEWARK CENTRAL PLANNING BOARD
                                       CITY OF NEWARK, NEW JERSEY

Application No. __________________                                       Filed_______________

PROOF OF SERVICE OF NOTICES REQUIRED BY STATUTE OR ORDINANCE MUST BE FILED AND
VERIFIED WITH BOARD SECRETARY AT LEAST TWO (2) DAYS PRIOR TO MEETING OR CASE WILL
NOT BE HEARD.

STATE OF NEW JERSEY)
                                      ) S.S.
COUNTY OF ESSEX )
__________________________________________of full age, being duly sworn according to
law, deposes and says, that she ( ) he ( ) resides at_________________________________
municipality of______________________County of____________________________________
and State of______________that she ( ) he ( ) is ( ) are ( ) the applicant (s) in a
proceeding before the Central Planning Board of the City of Newark, New Jersey, being an
application under the ______________________________and which bares the application #
_______________________and relates to premises more commonly known
as___________________________________________________________________________
that she ( ) he ( ) did on ______________________________20______ at least ten (10)
days prior to the hearing date of this application did give personal notice to all property owners
within 200 feet of the property which is the subject of this application and municipal utilities.

�� Said notice was given either by handing a copy to the property owner, or by sending said notice by certified mail.
�� Copies of the registered receipts are attached hereto as Exhibit “A”.
�� In addition, notices were also served upon: (Check if applicable)

( ) The Clerk of the municipality _____________of County of___________________________.
( ) County Planning Board.
( ) The Department of Transportation.

A copy of said notices are attached hereto as Exhibit “B”.

Notice was also published in the official newspaper of the municipality as required by law.

Attached to this affidavit as Exhibit ‘C” is a list of owners within 200 feet of the affected property who were served,
showing the lot and block numbers of each property as same appear on the municipal tax map, and also a copy of the
certified list of such owners prepared by the Tax Assessor of the City of Newark, which is annexed hereto as Exhibit
“D”.

Notices has also been given by the applicant to tenants of all residential properties of more than four (4) units by posting
such notice in a prominent place in a lobby or hallway of the building as required by Newark Ordinance. Attached hereto
as Exhibit “E” is a list of all residential properties of more than four (4) units upon which notice was posted in the lobby
or hallway of the building.

____________________________________
(Applicant’s Signature)
(To be signed by the person who served this notice)

Sworn and subscribed to
before me this __________
day of_________________.


                                                                                                                          13
Newark                                                                Cory A. Booker
                                                                      Mayor



Department of Economic & Housing Development                          Adam Zipkin
Central Planning Board & Board of Adjustment                          Director

920 Broad Street, Room 112                                            Arcelio Aponte
Newark, New Jersey 07102                                              Director of Operations
Tel: 973-733-6333
Fax: 973 733-4369                                                     Ade Afolabi
                                                                      Supervising Planner, LDR
                                                                      Zoning Officer



                                   FOR APPROVED PROJECTS
                       SUBMIT AT THE END OF DEVELOPMENT/CONSTRUCTION
This document must be submitted to and accepted by the Central Planning Board or the Board of Adjustment
prior to the issuance of any Certificate of Occupancy or the return of any performance bond. It is to serve as
certification that the project was constructed and developed in exact accordance with its approving resolution
and the approved plans. It must be competed, signed, and sealed by a licensed architect or engineer.


Date: _______________


To:      Board Secretary
         Central Planning Board/ Zoning Board of Adjustment
         Beth Tanzosh, Dept. of Engineering

Be advised that I hereby certify that the project at:

Block: _____________________________                    Lot(s): ___________________________

Address: _______________________________________________________________

Project name: ___________________________________________________________

Applicant’s Name: ________________________________________________________

Date approved by the Central Planning Board or Zoning Board of Adjustment: _______________

was completed in exact accordance with the site plan approval granted by the Central Planning Board or the
Zoning Board of the Adjustment, and all provisions of Newark Revised Ordinances Title 38, Chapter 10-Site
Plan Review as amended and supplemented were complied with.

Architect’s/Engineer’s Name:_____________________

License Number: ______________________________

Firm Name: __________________________________

Address: ____________________________________                         _____________________________
                                                                      Architect’s/Engineer’s Embossed
Phone #: ____________________________________                         Seal & Signature



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