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ZONING PERMIT ,APPLICATION www.countyofdano.conn <br /> PROPERTY OWNER" NF. � ���._t�-=-„ X r;�r��� r .� �;� -- -. - - - <br /> .-_t.it_ --- .� ..,ORMATIO.�,.tom? ; ;: .k s raa� } :e- i 'r CUSTOMER TO PROVIDE <br /> OrFEt NAME f.�-_ . <br /> ,\GSQ t%---)"" r;`gS 0-eCG e r oning Status; CUP; <br /> OVER ADDRESS (Number,Street,City,State// ip) ) /� Deed Restriction; CSM <br /> -i 0 ,`S - t . ( V)K Vance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _ <br /> Site Plan drawn to scale <br /> AGENT<TINFOYRMATIOi1B _� W ;COINTACTO INFCRNIITI„Na and includes dimensions <br /> AG T N I/1 E CONTRACTOR NAME <br /> fe ok. PFGt`rnp 00 ite Plan including location <br /> AGENT ADDRESS � CONTRACTOR •••:ESS of well/septic <br /> S <br /> (city,State,, I � /� �v city,State,Zip) Setbacks• <br /> PHONE P PHONE n Site a pproval from <br /> - -?5-)--7- --- -- - app.lielble township. <br /> E-MAILADDRE55 E-MAILADDRESS - - <br /> n Floorpla o scale <br /> PROP0,RTIf/LOCATION I.0-0:0A SON tiffPN/acce Olti :610.1 , irus/) <br /> PARENT PARCEL NUMBER: .- CURRENT ZONING ACR E: n Elevation roperty <br /> �3 <br /> PARCEL I � - front drawn to scale. <br /> NUMBER 0 6o �Sa-gN3o0 R4 -- <br /> TO. SHIP: SECTION: I <br /> Q,(`t? �� S '/4: 0 \,-J ,/4%4. ❑Drivewa rmits <br /> (Stat , coun , town)ADDRESS:Q D .', a, )/( Sanitary <br /> . . n permits <br /> CSM: LOT SUBDNISION BLOCK/LOT <br /> D q i (publi6, private) • <br /> PROPOSED-PROJECT INFORMATION :y," ;;:/Y , - r ° - RfajE'y" <br /> PROJECT D RIPTIO : 1 _ _ m , _ <br /> 0_,. 1,,-r/ • —4- 1-e r t7 FM e'G C —2,a <br /> []This project is a new building or-structure. • e ,o -se- <br /> ❑This project is an addition/alteration to an existing building or structure. r� y_ �- <br /> SANITARY SERVICE: PERMIT NUM: R: s -- <br /> _ 'FEWER - DEPTIC �. ell _ ' :-�t3.__ <br /> HEIGHT IN FEET: NUMBER• STORIES: (Not including basement) € - ---'-: <br /> / mi, ''L'e0 @i 11:1x* <br /> AREA TO NEAREST SQUARE FOOT ,���- -Q -?` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ ' <br /> BASEMENT; - 1ST FLOOR: � rP T. �' ee t , <br /> ' 4, TOTAL SQUARE FOOTAGE: 4, ` i-'- o oe 6 m mss-,-- <br /> 2ND FLOOR: 3RD FLOOR: 3 W F-a <br /> �C . Leo e a p_ 0 �' <br /> ESTIMATED CONSTRUCTION COST: 4-}_` �e- " <br /> (Please round to nearest dollar) ♦ "� "■ �� =-T� - :L �_. - <br /> jI <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake'? Dies ' ONo.• f Dol�'t- ndvr <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo -ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Oyes OW?, •• _ <br /> 4, Has-there been a zoning permit issued for this property in:the past 5 years'? OYes ONO . <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) - - CYes QNo • ODon't know <br /> 7. Is this to correct a violation? • [Yes ON <br /> • <br /> • APPLICATION MUST BE SIGNED <br /> - • (Continue on Back) —► -* -4- <br /> 545-t124/O8) <br />