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ZONING. PERMIT APPLICATION www.countyofdan.e.comUPPLEMENTtoWeb•App; =
<br /> `PROPERTY,OWNER?INFORMATION_- ,,:` i a _art,_, h% d_ ,SE'EE"r -? CUSTOMER TO PROVIDE
<br /> OWNER NAME ,n,
<br /> 't't" �` n Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City, tate,Zip)
<br /> o _ c ` �, Deed Restriction; CSM
<br /> 2 .gAI R "1-'t ti-t-, 1 rittr ,-t / �"� 5 5_90 • Variance(# )
<br /> HOME PHONE CELL HONE E-MAIL A DRESS /L
<br /> Ge� • 2-51 `{3s7 • Gt0ASh vv►-PI(bXI-- 4 12,`0 c n Site Plan drawn to scale
<br /> AGENTVINFO MOO IO,NIi,' teaMS EI rCOI!1TRACT0:051NFO10.T1 Wit yr, a'' and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> (dt-at. h,. !'Ld/YL4wr1P.r) n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (city,State,Zip) (City,State,Zip) n Setbacks
<br /> PHONE PHONE ❑Site Plan approval from
<br /> • applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS -
<br /> ❑ Floor plans to scale
<br /> ;PROPERTY/LOCATION�INFORMAtLOMr (http l/access lane.co,dane:vp.us/)� L�: ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: . CURRENT ZONING: ACREAGE:
<br /> 11 PARCEL n frontage drawn to scale.
<br /> NUMBER eSS-/eg//=/9z-9boo - y A -1 (c�' - Ilt
<br /> TOWNSHIP: SECTION:
<br /> 76,,,,v, a.r Pelf f'r c ,/4. ,/4,/. E]Driveway permits
<br /> ADDRESS: 61 (state, county, town)
<br /> .O Q d 13aj Pt^-1 1 5.��, IPk f1 r ''' -, _ t'l'2 �3 5--D
<br /> CSM: SUBDIVISION BLOCK/LOT n Sanitary permits
<br /> (public, private)
<br /> PROJECT DESCRIP110N: v * z m t e --
<br /> t4 his project is a new building or"st p
<br /> �Remid a . �x
<br /> -
<br /> K. ft
<br /> This project is an addi ' n/alteration to an existing building or stru -
<br /> SANITARY SERVICE: PERMIT NUMBER: -
<br /> A TeS E
<br /> �EWER EPTIC W a1/
<br /> 1T1e1 } S
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �` }6 e' f"-
<br /> 7, - e 1- AG3 lAlTetlar�d/FIOO.d Ifflain
<br /> Shp e or wtacanaprit i-
<br /> AREA TO NEAREST SQUARE FOOT: ap� �°�-
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) _- -r.r::1 ;,
<br /> tiQ EE0SIOpC-orl perridlt -T
<br /> BASEMENT. , 1ST FLOOR. -- ,: -�---- f 2,°
<br /> Q t°'' / /', " 4, TOTAL SQUARE FOOTAGE: 4, }3ES ?t �
<br /> 00 l[ J g-t cce5 r
<br /> 2ND FLOOR: 3RD FLOOR: q ,. //\ _ � �
<br /> / / ` Z ="h am-,...." S iz• �. K
<br /> ' It evte-eati.niS
<br /> 'A ---•ESTIMATED CONSTRUCTION COST " 9x
<br /> (Please round to nearest dollar) $ ( 7
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ©No.- nDon't-know
<br /> 2. Is there a wetland or floodplain on or near the property? Efres ❑No .❑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? ❑Yes ONO : - " .
<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) Oils ENo . Don't know
<br /> 7. Is this to correct a violation? - [Yes No .
<br /> APPLICATION MUST BE SIGNED
<br /> • • • (Continue on Back) -► -► -4.-
<br /> 545-112{4ro8) -
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