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ZONING PERMIT APPLICATION wvu v.countyt�#dane,com SUP NT to We An
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNS NAME
<br /> , I r r _ — D Zoning S s, CUP;
<br /> OWNER
<br /> OWNER Street,City,State.Zip)
<br /> _ Dee eSt
<br /> riction: CSl
<br /> !r� i &'/L ,;e/i,iQ� V ante I
<br /> HOME PHONE C t.
<br /> PHONE E-MAIL ADDRESS
<br /> G'' � ..32—/ / c''O�- V6,7°- 9. ,z.e>1 Z -CI v11;%11 e a J Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 2
<br /> r
<br /> AGENT NAME i CONTRACTOR NAME .
<br /> J . t. �,,+ irr�Idiom , Li Site Plan includina location
<br /> AGENT ADDRESS CONTRACTOR,�4 RESS , f well/septic
<br /> 1 /9e c /, Sr
<br /> (City,State,Zip) '(City,Flyt,,Zip) Setbacks
<br /> PHONE 'PHONE Site PI approval from
<br /> . .._.! °c> - 'I/ _ ,9 7 appli ble township.
<br /> E.-MAtLADDRESS (E-MAIL ADDRESS
<br /> © loor ans to scale
<br /> PROPERTY/LOCATION INFORMATION Mftp://accessdone.co.dono.wLus/) Elevation of property
<br /> PARENT PARCEL NUMBER: 1 CURRENFZO G: ,ACREAGE:
<br /> O
<br /> NumaEs 0/67,,k4.
<br /> ‘r/2 ' -1SY--. / frontage dr n to scale.
<br /> TOW St1iP: 1 SECTION:
<br /> I /? . , , tl ,,. , .. Drive ay permits
<br /> /�' ,�7'I 4 'A' _._.�..._ (st e,county,town)
<br /> ADDRESS: J
<br /> r7* � 7 i Lf / , Li Sanita permits
<br /> 1 SUBDIVISION i BLOCK/10T
<br /> cs/e, 3 7 I L } (pub`c, private)
<br /> PROPOSED PROJECT INFORMMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION:
<br /> oning District
<br /> This project is a new building or structure. Permitted Use?
<br /> U This project is an additio Iteration to an existing building or structure.
<br /> .s
<br /> D Rural SANITARY SERVICE: i PERMIT NUMBER l;� _
<br /> 0 SEWER l._.. SEPTIC j (new.
<br /> HEIGHT IN FE y NUMBER OF STORIES (Not including basement)
<br /> L Wetlan loodpiart-
<br /> _.—
<br /> Shor and (attadhment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches(
<br /> _. �.,�._. — C-1°ErosionControl permit , , t
<br /> BASEMENT 1ST FLOOR.
<br /> 4, TOTAL SOLIARE FOOTAGE. ,, ,;(sliopes,disturber , a I
<br /> flinglacc eSs y. . t
<br /> 2ND FLOOR: 3RD FLOOR: ,r
<br /> t ,
<br /> _._ .._......_.. 0 .Review ation, inlay-
<br /> ESTIMATED CONSTRUCTION COST: ' and a ilable`aptions.
<br /> (Please round to nearest dollar) `4 -4. -4 -4- ,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ........,.. °LiYes SNo U Don't know
<br /> 2. Is there a wetland or floodplain on or near the property?............................................ D Yes No Q Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? .... A.Yes G No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ............. D Yes , to
<br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal#f ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) LJYes ,,,X,No ❑Don't know
<br /> 7. Is this to correct a violation? Li Yes ANo
<br /> 411 (D? 0 i '----- APPLICATION MUST BE SIGNED
<br /> (Continue on Bach) + -* -►
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