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• • <br /> . • • . <br /> SUPPLEMENT to Yieb-APP # <br /> ZONING PERMIT APPUCATION www.cotmtyofdane.con <br /> - . <br /> . • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> owNER NNE \ i . • . <br /> V e-e-C SI 1 a ra 6 I a L L—C. 0 Zoning Status;CUP;m <br /> CO 4.• •ILI 'I-64 , i is kii Icmi .if tr' YarlanceDeed Restricd°110,---- <br /> - -);CS <br /> AA -. • CELL PHONE SAVULADORESS <br /> "°,101 <br /> ....w.., 0 Site Plan drawn to sae <br /> AGENT INFORMATION }CONTRACTOR INFORMATION and indudes difnenSiOnS <br /> CONTRACTOR NAME <br /> &ilia i&i 1 MID- li '11 .0 V.e_ CI Sfte Plan including location • <br /> c•al- "7s-, COMIRACrOR ADDRESS .of welliseptIc <br /> Pt%0010.MP) (CIPASIIPIN ZIP) . 0 Selbado <br /> • • <br /> PHONE PHONE • 0 Site Plan approval from <br /> . , applicable townshiP• <br /> E4NALMIORESS E-NALADDREMI <br /> . 0 Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wv.us ) 0 Elevation of proPeitY <br /> IDARBIT • - •= NUIMEFt 4:,7zi 7 ..., .., . ZONINIA ACREAGE 0? frontage drawn l°scale. <br /> 1:3 PAItc9! 0'' iir'' - r- <br /> Towpis‘i a • <br /> 70 , %IA: 0 Driveway Permits . <br /> AI I .3.4.J...,4 (state,county,town) <br /> ADDRESS: <br /> 6 a <br /> • II ' IP k441.4er 0 Sardtar1 WM" <br /> CSM: COT iiii-•'-'.• ' cir 4 - 6- • oubkprivato . <br /> 5,.. <br /> PROPOSED PROJECT INFORMATION <br /> FROJECT DESCRIPTION: - <br /> Ft _ V Q.L.0 0.--(PNCCtri.cx...fi-cin <br /> • I7- This project is a new building or structure. <br /> SANITARY SERVICE PERMIT NUIABER <br /> 0 swag 0 sEFnc 3 9 <br /> HEIGHT IN REM • -4--. . A NUMBER OF STORES, . IndudIng Issament) <br /> ar AMP, • • <br /> AREA TO NEAREST SQUARE poor. <br /> (Outside dimensions including unfinished area, ,. • . - .• and above grade decks or porches) <br /> ,-• • 1 wsrmoon: ' 6 <br /> to' • . Asolir a- <br /> • _iii A, 4,TOTAL SQUARE FOOTAGE 4, <br /> 2ND FLOOlt SRO FLOOR: <br /> . •. . :641:14-r- / .VESIIIPIIMIII <br /> ESTIMATED CONSTRUCTION COST $ ;13 tB '5 9 .1 <br /> (Please round to newest dollar) -e. -p -* -o -■ -, <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?........... 0Ys ligho •C3 0°1 kn" <br /> 2. Is this a wetland or fioodpiain on or near the property? 0Yes Wio GI Don't know <br /> 3. Have you talked with the tovmship about your project and are they in agreement? Grtis 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?..... °Yes &filo <br /> 5. Is this project associated with a rezone/CUPArariance(petition/appeal# _____) ($e blank I none) <br /> 0)10 C:3 Don't know <br /> 6.Is a location survey required? (see reverse). <br /> 7. Is this to correct a violation? 0 Yes MN° . <br /> N1 8 i % a APPUCATION MUMIlr BE WPM <br /> (Continue en laselc) *. -0 "" <br />