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4.01 EMENT�to Web�Aiiii <br /> ZONING PERMIT APPLICATION www.countyofdano.com - . <br /> PROPERTY-OWNERjINFORMATION _ ;;y c r� cU TOMER TO PROVIDE <br /> OWNER NAME r <br /> t�I 4) Ho-fni P 0.4.4"/"/ / 1 ;r ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State, <br /> Zip) - eed Restriction; CSM <br /> It to g 54-0fP ( ea.cl n - 14 / T. tto- C/ <br /> wT ariance(# ) <br /> HOME PHONE CELL PHONE E- AIL ADDRESS - <br /> Got '13 9-it c. r,661 GS b'- Z9 GS Ih o f.Pt ""' "IAA-rely-- Site Plan drawn to scale <br /> ,AGENTIINFORMATIOIt1„ v �ti„ fCONTI ACTOR INFORi gT10N m fig, - nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) . (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ ite Plan pproval from <br /> - pplic e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS - - <br /> Floor plans to Cale <br /> PROPERTY/LOCATIONINFORI)AAtION :(httpa/accessiiane co dane.vin.us/)� -_ -. i: ❑ Elevation f prop <br /> PARENT PARCEL NUMBER: CURRENTZO ING: ACREAGE: <br /> ` ? ( -. frontag dra to scale. <br /> ❑PARCEL e 06:. off! ' / t �/ — ? - - /�X <br /> NUMBER( '�t� FFF--��� ""�� <br /> TOWNSHIP: • 1J r C SECTIO ,/a: c ' h�a.,. ❑ p <br /> 1Vi � /� Drivew permits <br /> /y (stat county wn) <br /> ADDRESS: t( � . � I v v <br /> "ici_r? ❑Sanita ermits <br /> CSM: LOT SUBDIVISI■N BLOCK/LOT <br /> (pub• private) <br /> PROPOSED PROJECT INFORMATION ` _ .: _. .__ .. 3N cc T _=RE�!EIIV �� <br /> �: i _ 5 {" <br /> PROJECT <br /> DESCRIPTION; � <br /> o <br /> m Di };.% ue.': <br /> This project is a new building or-structure. r w E 4' <br /> 0 p 1 9 I ∎ed[js " _, <br /> ❑This project is an additio Iteration to an existing building or struct re. _ � _ a <br /> SANITARY SERVICE: PERMIT NUMBER: k <br /> . DEWER - EPTIC r < '6, 6- `. i4� <br /> HEIGHT IN FEET "1 NUMBER OF STORIF�S; (Not including basement) , � _' <br /> C:j)` ( i 13olrowi 11:1Y <br /> Ow- as -y -*::-,._;r.r. I <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) D s ` <br /> BASEMENT: 1ST FLOOR: <br /> - 1 TOTAL SQUARE FOOTAGE: 1 °: � ;°� ,4 —. <br /> 2ND FLOOR: 3RD FLOOR: / /' /� ° ` ___ `u - �� � <br /> ESTIMATED CONSTRUCTION COST: , t'L ` <br /> (Please round to nearest dollar) Q ) © 0 _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ' I jN - ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes gi o .❑Don't know . <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes 1/ - . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years'? Elves AV o . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave bl if none) <br /> 6. Is a location survey required? (see reverse) Elves o • ❑Don't know <br /> 7. Is this to correct.a violation? - Dyes _ <br /> . ____Os. — APPLICATION MUST BE SIGNED <br /> (Continue on Back) --4 -4 -4 <br /> 545-112{4/08) <br />