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46i.- I © U ,LEiYIaN-: t eVAPP #7 <br /> ZONING PERMIT APPLICATION www.countyoidane.com <br /> • <br /> P.ROPERTYaOWNEI INFORM.' ..tQf , ` �; l ." .4T -'s. .`:ft z CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1 Jff_2•IwiS ± I v 114rt � O'vALTL° ) I I Zoning tatus. UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re .ction; CSM <br /> 1 510 ► 6'tEt SRC. (A.)v't`) , r1ikpi 1 wl SR L( Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • - to •A C . • r @ tic,',_ I Site Plan ra to scale <br /> A;GEIi4T1NFpR�IIlAT10�1 rf' °FON ,Tt/ tF01 „TION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME �p <br /> CHICIS Eve 'e 1 ✓1A,�J D�►1� s Lk.-C I I Site la Including location <br /> AGENT ADDRESS COO^�AQCTOR�D�S - of we septic <br /> Sti1 �• S <br /> (City,State,Zip) (City,State,Zip) Set ks <br /> Lr+k` Mit,.S Nair 53SS 1...."V K;.. i\f,fx ' <br /> PHONE I PHONE Site Plan s•pr:v from <br /> 9 — Qc —36"Z Goo- -y%`•'1---9'� 3-" applica It.4 Ip. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Ce re4 -S�. a LT" •re. Cel erS'o'd�C �. -f I Floor • a s to scale <br /> z 7c1 Sz`-2'1'iS4`Y.'}�/2-.er, .s � <br /> �P,R,O1fRBTY/LOCATION_s114 I1AAT�O`r.• (htt ,//access ane cc n :ys/)�' <br /> A - '� Elevati o ro ed <br /> PARENT PARCEL NUMBER: CURRENTZ ING: ACREAGE: / p y <br /> 'PARCEL �Q ^ /�� LFf frontag awn to scale. <br /> NUMBER Le 10-o3'-{-SO1?-1 ///���-----���� • ke <br /> TOWNSHIP: SECTION: <br /> -134_.1 R<C2- sN 1/a: s.e. C 1Y41Y4: Drivewa pe its <br /> ADDRESS: O geti-F/Aa,ri 2 (state, co y, town) <br /> CSM: LOT SU:•IVI tt!1 LLOOCCCK/LOT Sanili per Its <br /> s'■ (public, r ate) <br /> •PROPOSED PROJECT:_INFORMATION « <br /> _...la:.,-rrg. '� STAi~P REVI Elft! *-,' <br /> PROJECT DESCRIPTIO n p5v–c- 4 , , }°r a C <br /> `I/G/— P omng I c 4 L. <br /> . his project is a new building or structu e. ttliggiiiitte set <br /> [1This project is an addition/alteration to an existing building or structure. <br /> aK ' '1-'*"r4 <br /> ti ; <br /> ` te <br /> SANITARY SERVICE: PERMIT NUMB ER: 1%1AddreSS�r i . e <br /> _ �rf e ,,$ �SEWER WPTIC 13— .^O `C►–O�g�. , v. <br /> . <br /> g x HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) u' j i; Wetl • .••alnf y <br /> AREA TO NEAREST SQUARE FOOT: ErShOr � d �C11'1'a @7 ) _ <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) }�'a "s �' - h <br /> BASEMENT 1ST FLOOR: [0510x1 . <br /> -653 I j TOTAL SQUARE FOOTAGE 4, G ,,_SJCC es yF,A� ? . <br /> 2ND FLOOR: 3RD FL OR: ` s' � I 13 SS yrr# ! 4' <br /> a i V v�' `®ea , $ 4. <br /> ESTIMATED CONSTRUCTION COST: arr® t ,agile a torts% <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ -� $ l 8 S , �'� 3 r= `-,74,'s 4 kY_ <br /> -Y2- li <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ISITOT f Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes is ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? .... j>itres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes FIN() . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) es EN __Don't know <br /> 7. Is this to correct a violation? EYes , o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) –► –► –+ <br /> 545-112(4/08) <br />