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. --7 v <br /> ' ZONING PERMIT APPLICATION www.cauntyofdano.c©m I. ,-.L E M E - to .', AL-A: : <br /> -F' PERTY C , NEF I . F: F . A-I :, . CUSTOMER TO PROVIDE <br /> OWNER NAM' <br /> �� ` Zoning Status; CUP: <br /> OdYhiEP, [Numter, Ci t e, ip Le\ t _� �G ) 3�a� Deed Restriction:CSM <br /> Variance(#_ ) <br /> HOME H NE CELL PHONE E_Ni AIL•-. RESS <br /> .�, CH'�iSac�� d 7T (d LO 4 •,CCU.. <br /> -r� 'Site Plan drawn to scale <br /> A:.E _ - INF: RMA-10 : : -RA: "OF I . FIR , A-. 1 : and includesdmensions <br /> AGENT NAME CON TRACTCP,NAME <br /> Plan inducing location <br /> GENT ADDRESS CON RAC r.-ADDRESS of well/septic <br /> (City,State,Zip) (City Slate,Zip) racSetbacks <br /> PHONE I HF� HF ONE $ite approval fr <br /> pplicable Plan atoprownship.om <br /> E-MAIL.ADDRESS E-MAIL `� <br /> Floor plans to scale <br /> -'F :`PERTY/L T 1 0 I F : F :A-1 : (htt_ / acce sdane.cz.d nA. :.i.J',/ Elevation of property <br /> PARENT PARCEL NUMBER. GUPRENTZONING rV.REAGE: pr y <br /> ❑ PARCEL E Q Gin "3 '6�.�- ` S i frontage dawn to scale. <br /> TOWNSHIP: SECTION ' �{ i <br /> O t/4: 14141: Drivew erm its <br /> ADC,RE�s - ( ,co nty,town) <br /> C� 4 P8 1.): 0(11- 3 V, . 14 0 I 535—a ( ❑ Sari rmits <br /> CSM: i LOT SUBDIVISION I BLOCK/LOT <br /> 4 3 (p lic, ivate) <br /> 'p: P: SED -F : ECT INF:RMA-10 4:trAffli.:E* <br /> PROJE;TDESCWPTION <br /> r <br /> • This project is a new buildng or structure. P ? <br /> ®This project is an addtion/alteration to an existing building or structure. <br /> SAN ITARY SERVICE: PERM IT NUMBE Rural . �.,,� <br /> ❑SEWER V SEPTIC <br /> HE ID-IT INFEET -1 NUM BEROFS IES (N!tinducngbae n t) <br /> ��. llif�k 1::;::44:0000:.:....,.. .:::::::...::: <br /> Sh nt <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions induding unfinished area,attached garages and above grade decks or porches) :0::-: Id o11 y.`. <br /> _ .BASEMENT. 1ST FLOOF?` , /' #': <br /> 3 �ilC� ,} TOTAL SQUARE FOOTAGE: +, '. �� '� �X1�Bx <br /> 2ND FLOOR 3FD FLOOR' t c� <br /> f l Revlie ,, t' Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ .4 .4 ..4 -► pG andia ,s cleo�pn <br /> (Please round to nearest dollar) S , <br /> 1. The property is within 300 feet d a stream or 1000 feet from a pond or lake?........... ❑Yes a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the operty? ❑Yes rallo ❑Don't know <br /> 3. Have you talked with the township about your roject and are they in agreement? a Yes ❑No <br /> 4. Has there been a zoning permit issued for this roperty in the past 5 years? ❑Yes INo <br /> 5. Is this project associated with a rezone/CUP riance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 2 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br />