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ZONING PERIVIT APPUCATICI\I vimivecoultycicknacan . . . . ,. .
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Ali z-b.6 -c rtiiP It--/ file fti;zr i< .f Lu.:
<br /> 0 Zoning Status; CUP;
<br /> OWNER ADDRESS (Number.Street,City.State,Zip) Deed n Restriction; CSM
<br /> 3`e s
<br /> C) ?1,-,..“,„,-i P-( o4 VQ4---6-.14, , (A( $35-93 a
<br /> Vriace(# )
<br /> HOME PHONE i CELL PHONE E-MAIL ADDRESS 1
<br /> (Oc6 %Zi 9 7 608 3T lett 444\m(- 1.At Ii.ke...s Q " ekt\0 e),c e in Li 1---i Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> CleAS-1 Ck.i 1J ■if13 G ci fl Site Plan including location
<br /> AGENT ADDRESS CONTRACTOPIADDRESS of well/septic
<br /> --?0 8 V( 41'1 022 0
<br /> (City,State,Zip) (City,State,Zip) El Setbacks
<br /> VC,re -A a IA 1 S3 5 ?3.
<br /> .
<br /> PHONE I PHONE i Li Site Plan approval from
<br /> Lu 7,45 c)70-t, applicable township.
<br /> , 1
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> hifkiNt 4 ca:•ELtte,i ,LA., I 4 t,4 .C.40) t Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdanexo-dane.wLusi)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: DI j Elevation of property
<br /> 0 PARCEL 0767-26 --2..-- 7710 .....0 A_....z_. 3-4 , 75i frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> -I C t%)i i: C 1-- e P,e-S c Q LA i r\SS 3 4-'7--) ih: •E, ihiA: ,,,,i j. El Driveway permits
<br /> (state,county,town)
<br /> ADDRESS: i •
<br /> 17)ctos e-r 12.,ck C j c _cc lb 1 ct i ii 1,,,) i 535-2 1:::1 Sanitary permits
<br /> CSM: LOT SUBDIVISION i BLOCK/LOT
<br /> i LI ;),21 2_ i (public, private)
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION.
<br /> L.10 r A tIV-+Oki e d t ) c....CA OVC-Ct)ck.,11 1 5 0, kk, 14ing District
<br /> OThis project is a new building or structure. "Permitted Use?
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural ' ••_.- s
<br /> FFEVVER KIEPTIC iI' )
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> i 21 Wetland/Floodplain/
<br /> Shoreland (attachment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches)
<br /> BASEMENT 1ST FLOOR afErosionControl permit
<br /> • 6
<br /> ,a. z-c' 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance,
<br /> filling/access)
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> .3-akrir ZU [2(
<br /> Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: ..- available options.
<br /> (Please round to nearest dollar) -OP •••• -b. --1, $ 7 — 1 \
<br /> ( t"' ('-'
<br /> )
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Z. o ODon't know
<br /> 2. Is there a wetland or floodplain on or near the property? DY'es g.No aon't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Oves $No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? , E yes IZINo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 6 z3S ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) Yes a o ODon't know
<br /> 7. Is this to correct a violation? :fres 0, o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —ts, —so —..
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