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,7,,witigNIENTAtomeklootif <br /> ZONING.PERMIT APPLICATION uwuw.countyo1dano.com <br /> `PROPERTY`OWNERtINFORMATION --- .. .:=r W,_-,. 3 r 514. ri - it k aK CUSTOMER TO PROVIDE <br /> OWNER NAME " <br /> 111Jaa-FI v'4" - +�E p ''. n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 1Z) i"7 g� i.i i.41 t rf3 Deed Restriction; CSM <br /> ?j Variance(# ) . <br /> HOME PHONE CELL PHONE E-MAIL ADD"ESS <br /> ,/J _ <br /> 0 O8 376 l •' V. r 5 wootA 5(-o-- 7 S 1/ n Site Plan drawn to scale <br /> aAGENT(INFO_ RMATION;,1•'` R sr,.g CCONTI ►CTORry1NFC01M10N Ciag , and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �v ota-5 (,U oo(s o•" n Site Plan including location <br /> AGENTADDRESS CONTRACTOR ADDRESS - of well/septic <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> /t ,(10,9- (A4 53 sy;)_ <br /> PHONE PHONE ❑Site Plan approval from <br /> 608 c/6_ 6y›.9 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> v44 Gritm rit-5 - <br /> 5,,-(, ❑ Floor plans to scale <br /> PROPERTY/LOCATION IN .0040 TION> (http.l/accessdane.co,dane:vlri.us/) zit 1--1 Elevation of property <br /> PARENT PARCEL NUMBER: . CURRENTZONING: ACREAGE: <br /> PARCEL O 506.0�I_506,2_0 � _f - .2 6o frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: - SECTION• ,`, <br /> , : N E 1/41/4: , ❑Driveway permits <br /> ADDRESS: C �+ /J/� /. ,, (state, county, town) <br /> cqL Ova_ v 4 / °T'-f erg G� 5-7,73,- n Sanitary permits <br /> CSM: LOT JSLJBDMSIO,4 BLOCK/LOT <br /> (public, private) <br /> • , • , . ST-i0 REVIIE1111 <br /> PROJECT DESCRIPTION: 1712.4_114i <br /> to E F `'n? <br /> . ❑This project is a new building or.structure. L�aiPermlfted'Use's A' <br /> ['This project is an addition/alteration to an existing building or structure. ° i -4W. 4 <br /> SANITARY SERVICE: PERMIT NUMBER: T-al-Addre s5 w; <br /> . r)EWER [EPTIC I R.o)I.- 0 005-9 ar.. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) �-''si r _1- 14 .z g <br /> C_4Watla>id/FIWJDI�lrt z <br /> AREA TO NEAREST SQUARE FOOT .. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ` - ep : <br /> BASEMENT 1ST FLOOR: ''. 5:,t Q �C 1�flCOGI CQ �EC{ It <br /> 4 TOTAL SQUARE FOOTAGE: 1 it`, .,v44 5 S UT B � . <br /> 2ND FLOOR: 3RD FLOOR: 6 V - r•ESTIMATED CONSTRUCTION COST: w n � <br /> (Please round to nearest dollar) ♦ "0. '♦ ♦ -* --0. $ 10 00 if) d a��e 3P it�7t$, : <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ' ®No.• nDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? DYes EN .❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? . Yes ❑No. _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? RfreS ONO . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# /d6)0 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes No - ❑Don't know <br /> 7. Is this to correct a violation? - Des IINo . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. -•. -4- <br /> 545-112{4ro8) - <br /> • <br />