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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION wwwcartycidemecom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM / n �, / <br /> ,l4 (Z /\J �A V�,u V© ❑Zoning Status; CUP; <br /> OWNERADDRE (�ber,S tr�eQ t.City,Sta Z ip) <br /> � Deed c fiction; CSM <br /> v�n Po_.-7-r.) -1-- � { Variance(# ) <br /> HOME P ONE CELL PH NE Z E-MAIL ADDRESS <br /> ..1(114 -20 'd3( • 14 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> An Das(1 �, - J IIL�, vOC4t ViSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS _ well/septic <br /> 30 7 u biz <br /> -(City.State,Zip) (City.State,Zip) / `�� Setbacks <br /> AE �' R. a v b ❑Site Plan approval from <br /> PHONE PHONE IZ� �� <br /> '� applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> C�SS4-75S4 C-,� ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wt.usn <br /> PARENT PARCEL NU BER CURRE TZONIN ACREAGE: �/ ❑Elevation of property <br /> ❑NUM ER vi��� " -2v`��5T549 , N��F frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> VA-VDD LC N '/4: %41/4: ['Driveway permits <br /> ADDRESS: (state, county, town) <br /> I Ce(e Wb(14V PZ- -r- ,2,4 n Sanitary permits <br /> CSM: LOT SUBDI ISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION ( ■ ��/rD0 Co X 1Z..' "S R- c e: -= .. )NI Li Zoning District <br /> . This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> DEWER AEPTIC (new/existing) <br /> HEIGHT IN FEET. e.2 NUMBER OF STOKES: (Not including basement) <br /> /j/ Li Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST ST FLOOR I Li ErosionControl permit <br /> "702 j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: l filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ l 1/Q 0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Jlo j 4Ion't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ai. i.II on't know <br /> 3. Have you talked with the township about your project and are they in agreement? xi es 'U Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? A es ❑to <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes X74 o Eon't know <br /> 7. Is this to correct a violation? Des a o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />