TOWNSHIP OF BRICK

LAND DEVELOPMENT APPLICATION

Re-approval or Extension

Application NO._______________________________________

Planning Board _____ Zoning Board_________ Date of Submission _____-____-_____

Mo. Day Yr.

Application Fee $500.00 Escrow Fee $500.00

A. Applicant _________________________________________________________

Name

_________________________________________________________

Street Address

_________________________________________________________

City & State Zip Code

___________________________________________________________

Telephone # Listed ( ) Unlisted ( ) Fax #

(If not owner, set forth ownership interest, contact purchaser, etc., & attach copy of document following same).

Owner ___________________________________________________________

Name

___________________________________________________________

Street Address

___________________________________________________________

City & State Zip Code

___________________________________________________________

Telephone # Listed ( ) Unlisted ( ) Fax #

B. TYPE OF APPLICATION: New_________ Amended____________

1. Minor Subdivision ___ 4. Site Plan-Prel. ____

2. Major Sub.-Prel. ___ 5. Site Plan-Final ____

3. Major Sub.-Final ___ 6. Conditional Use ____

Date of Prel. App. ___ (Must be accompanied by

Site Plan)

7. Minor Site Plan ____

8. Cluster Zone ____ 12. C.40:55D-70D _____

9. C.40:55D-70A ____ 13. C.40:55D-34 _____

10. C.40:55D-70B ____ 14. C.40:55D-35 _____

11. C.55D-70C ____

C. PREVIOUS APPROVALS EXTENSION #1_____ #2______#3_____

Date ___-___-____ Type Variance_________________

Mo. Day Year

Approved _______ Resolution #_________

D. Location: ________________________________________________________________

Street Address

_______________ ____________________ ______________

Tax Map # Block (s) Lot (s) #

E. REASONS FOR REQUEST

DESCRIBE:

N. LIST OF INDIVIDUALS WHO PREPARED PLANS:

1. Engineer/ ________________________________________________________________

Surveyor Name

________________________________________________________________

Address

________________________________________________________________

City State Zip Code

________________________________________________________________

Phone # Fax #

2. Architect ________________________________________________________________

Name

________________________________________________________________

Address

________________________________________________________________

City State Zip Code

________________________________________________________________

Phone # Fax #

3. Site Planner ________________________________________________________________

Name

________________________________________________________________

Address

________________________________________________________________

City State Zip Code

________________________________________________________________

Phone # Fax #

4. Attorney _______________________________________________________________

Name

________________________________________________________________

Address ________________________________________________________________

City State Zip Code

________________________________________________________________

Phone # Fax #

O. AFFIVDAVIT OF APPLICANT:

STATE OF NEW JERSEY

COUNTY OF OCEAN

­­­­­­­­­­­­­­­­­­­­­­­­_________________________________ of full age being duly sworn according to law, on oath deposed and says, that all of the above statements and the statements contained in the papers submitted herewith are true.

Sworn and Subscribed to:

before me this _______ day:

of ________________, 20_____:

____________________________________

Applicant to sign here