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f <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> / <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> Homes for our Troops <br /> OWNER ADDRESS (Number,Street,City,State,Zip) IN oy�ing Status; CUP; <br /> D ed Restriction;CSM <br /> 6 Main Street,Taunton, MA 02780 riance(# ) <br /> HOME PHONE f CELL PHONE E-MAIL ADDRESS <br /> (508)967-9009 jmuse @hfotusa.org S' a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd irtludes dimensions <br /> AGENT NAME CONTRACTOR NAME // <br /> Silt Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Si Plan app` al from <br /> pl. abl wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dano.wkusn Ele tion of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑NUMBER 052/0510".3§,-^ RH1 3.79 fr t e drawn to scale. <br /> TOWNSHIP. SECTION: h/ .5 <br /> Rutland 35 1/4: .SE- 1/4+/: sue• eway permits . <br /> ADDRESS_ Old Stage Rd s fate,county,town) <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 13,829 2 NA NA (pub ,private) <br /> PROPOSED PROJECT INFORMATION ' AFF REVIEW <br /> PROJECT DESCRIPTION: ' ..rt, <br /> Build New single family home 'j4 f r0��4 ci- j^ecrt{— P 0 rC R Z,: n5istn , <br /> . DI This project is a new building or structure. ® erm ;'Use? ',,*:;'-::'-%:.:.;-:-''.'` <br /> ❑This project is an addition/alteration to an existing building or structure. , i. ';'. rx j` b -i\ <br /> SANITARY SERVICE: , <br /> PERMIT N?UMBER:((`j C �'t� U A(�f8$`$ <br /> EWER )EPTIC / ,.3 "-aV1,11 "</O,� 3 «(n6 �rlgl r4 ''''. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) * -� r, , rat'; e <br /> 23.0 :■ '11r-ft.:-.161- a . „ <br /> 'Pttg24/aItiimentj ' <br /> (Outside dimensions including unfinished area,attached garages OaOnd above grade decks or porches) ;'s5'a�, �e <br /> BASEMENT: 1ST FLOOR: s <br /> 0.0 3,600.0 j TOTAL SQUARE FOOTAGE: 4, '''"*.3.'"-, • • • <br /> 2ND FLOOR: 3RD FLOOR: II r•ta�` '. ,t.,.� <br /> 0.0 0.0 3,600.0 ' ,� , k ; 7. ., �,��s '^� <br /> ESTIMATED CONSTRUCTION COST: x i- <br /> (Please round to nearest dollar) ♦ ♦ — ♦ -+ ♦ $ 250,000.00 �' .,;-' t., ' 9'" (I�tI� �7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ff1 o is Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1 o 12 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes LJVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ✓�Vo <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) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? } Yes o <br /> 4.1) 0).C . Wes <br /> MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) -to ■ -► <br />