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I ' II' 1 11
<br /> ) i4 +1 ail
<br /> ZONING PERMIT AF' . LICATION www.countyc , .corn it YPPLEM 'NT to Web-App`#:
<br /> d I I I II it Iii n
<br /> PROPERTY OWNEFj II I FORMA ION Ii STOM,ER TO PROVIDE
<br /> OWNER NAME
<br /> lS I' L G ©0� I'=11 Zoning Status ;CUP;
<br /> OWNER ADDRESS (Numbdf,Street;CIty,Sta Zip)
<br /> ,� �� ` (� 1 r I Deed Restriction;CSM
<br /> -� �1�.II(Ng 770A) S )H 1V/ L I .I I Variance(# )
<br /> 2'77 HOME HO r� 5,5112-7911-1655-!; CELL'PHONE E-MAIL ADDRESS
<br /> t /- ���I '''I e hr
<br /> drawn OSCMaIe
<br /> AGENT INFORMATON ! CONTRACTOR INFO,1' �+ 'ON I and inc) des dimensions
<br /> AGENT NAME I'I I CONTRACTOR NAME I{lI,
<br /> I HI Site Pla&Including location
<br /> AGENT ADDRESS I I CONTRACTOR ADDRESS 11,1 I of well/ ptic
<br /> (City,State.Zip) 9 (City.State,Zip) 18 I Setbact
<br /> i l',N il
<br /> :1 H___]PHONE ' PHONE ' ![=11 Site Plap approval from
<br /> 1 applicap a township.
<br /> E-MAIL ADDRESS I i'. E-MAIL ADDRESS + ti. I!
<br /> ij I r I Floor pins to scale
<br /> PROPERTY/LOCATthp INFO' ATION (httpa/accessdane co dais r, ,!li.us� 11 it 9
<br /> PARENT PARCEL UMBER: CURRENT ZONING: i „E: I I Elevation of property
<br /> ElPARCEL ^�''II ,,.�,,// I t. frontagO'drawn to scale.
<br /> NUMBER Cam/ tJb111— 1 . 1 O"2 r�N J L? . t IN ('
<br /> TOWNSHIP: I SECTION: I Ut I.
<br /> [t 1 Drivew+ ° permits
<br /> PLEA SA N 1�I kpp1Ai ,s. ��a '/�: WE :�,'/<: S� i Nil(state,county,town)
<br /> ADDRESS: # i I I
<br /> I I till !`,
<br /> 1 b 55 G(f 1 i;14 /4 i-o N RO , 51( ��IU I 1- Sanita Ilrpermits
<br /> CSM: I 101 1 SUBDIVISION OT t .
<br /> �l 1 (public,!: rivate)
<br /> 033q-1— It Ili ii •
<br /> PROPOSED PROJEc�TI INFORM .■TION I I S REVIEW
<br /> PROJECT DESCRIPTION: Ii II I I I II t
<br /> F DP t rt c' J TO 1O VS,F co it-) T( N( ('0 M ,,; Zflging istnct
<br /> 'AuI Il II ita
<br /> ['This project is a ne buildi g,Dr structure, ,I"' r
<br /> Pent • Use?
<br /> Rills project is an��ddition/alt ration to an existing building or sir Pi: 1 t
<br /> SANITARY SERVICE: t( PERMIT NUMBER: I.t'I CRufaI .9 9 reSS
<br /> EWER 9 1 REP'[(ICIl :ir flew L°' 9ng)
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Nut easement) 1"
<br /> I i 2 _ li ,Wetlan t oodplainl -
<br /> i ,r:fShorel d (attachment)
<br /> AREATTO NEAREST SQUARE FOOT;
<br /> (Outside dimensions Irlca,ding Unfluiis ed area attached garages and above ticks or porches), „ C
<br /> BASEMENT: II II I �yS�.T' OOR F I �
<br /> I Erosio ontrol permit
<br /> 37 40 . , 1: r, iS?)A_ 2. s 6, Fr. �. TO'1 ,RE FOOTAGE. t, I i�SIoP6 9.isturbance, _
<br /> ( I ,filling/a+ SS)
<br /> 2ND FLOOR: �I I 3 D FLOOR: I
<br /> 11-~1- 5Qt .Il+l'I+ (� I' 1 Revie ocatlon Survey
<br /> ESTIMATED CONST4I41 ION(COS� ♦ ♦ ♦ . , ♦ ♦ tl and av - 'le options
<br /> (Please round to neariM aiollar) II 1 j
<br /> II Is ; I
<br /> iI I M
<br /> 1. The property is within 300 fe�t pf a stream or 1000 feet from a pc .ke? Ekes es /74 to QDon't know
<br /> 2. Is there a wetiand'hI floodplaln n or near the property? (,I es o ODon't know
<br /> 3. Have you talked wiit (Ithe towns ip about your project and are the .cement?.... es '.o
<br /> III�i.
<br /> 4. Has there been a zoning pa I issued for this property in the paE ,rs? es OC 0
<br /> dill II I:
<br /> 5. Is this project associated with a'rezone/CUP/variance(petition/ap, ) (�e( ve blank none)
<br /> 6. Is a location survey'��!Irequired see reverse) E,II es gel o ODon't know
<br /> 7. Is this to correct a`;Jlolation? es ONo
<br /> J I11 I'
<br /> 4 I 1 I PPLICATN)O MUST BE SIGNED
<br /> !! i i ContinueWon Back) —► —t► —I►
<br /> 545-112(4/08) t l i li I I
<br /> is ;,
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