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t a l b 5lioto ,LEMENT^to web•A >#- <br /> ZONING PERMIT APPLICATION www.countyofdano.com PP - - <br /> PROPERTY'OWNER^INFORMATION_ -eta,_` ;M ,_ . ; ; n.i g V ' tt sr;— .R CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 'Zoning Status; CUP; <br /> Deed Restriction; CSM <br /> ' Variance(# ) <br /> HOME PHONE CELL''ONE E-MAIL ADDRESS /. • - <br /> I Site Plan drawn to scale � , <br /> AGENT(INFORMATIOI� "u ti _v _,,w,t 1 CQNTRA;71rit 1NFO,Q lAt10N� ,, ; and includes dimensions <br /> AGENT NAME I CONTRA.7'. .,- <br /> n Site Plan 'n ing location <br /> AGENTADDRESS CON '•it RA+DRESS of well/se is <br /> (City,State,Zip) Setbacks a A s A' `l <br /> (City,State,Zip) ❑ <br /> PHONE PHONE ❑Site Pl?c AA, ov from <br /> applic00 o nship. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor pla scale <br /> PROPERTY/LOCATION INFOJtI)AATtOM>` t ittP.Uacceiisilaine,c_o,dane:wi.as%) 4_-,F z ❑ Elevati n property <br /> ❑ <br /> D S 34 7 L4. 9 �NING ACREAGE: <br /> PARENT PARCEL NUMBER: . CURRENTZi <br /> PARCEL D I p frontag drawn to scale. <br /> NUMBER I <br /> TOWNSHIP: - SECTION: <br /> ,/. ,/4,/4: El Driveway permits f�- <br /> ADDRESS: (state, county, town) AA- <br /> ADDRESS: <br /> ❑Sani f�+ •rmits V� <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu ]+ A_ e) <br /> PROJECT DES IP111ON� p :mot * t 5-4 <br /> r ekk� V ta:�� T w�_ ��4� N <br /> ❑This project is a new building or structure. 4 -17:01u-le` & �-- <br /> DThis project is an addition/alteration to an existing building or structure. ....%-4 -7,.. -- <br /> `1 A.a -s --.0-c5.----- <br /> SANITARY SERVICE: PERMIT NUMBER:' - <br /> mar —> x <br /> DEWER - pkEPTIC .& «�, ' � 44-c4 trlc <br /> E >` ' <br /> HEIGHT IN FEET l NUMBER OF STORIES: (Not including basement) * – 4 <br /> al-1 o a o -T_ __a•E <br /> �� '?- ilia 0 � f - <br /> AREATO NEAREST SQUARE FOOT l` �'� ay 11[�'1jf <br /> (Outside dimensions including unfinishe a ttac ed 5-a s dtebove grade decks or porches) ° °"E . <br /> BASEMENT '/� 1ST FL O U 1 TOTAL SQUARE FOOTAGE: j ` 4O�° :� i�► ,1 �.' <br /> ( _t. <br /> - I V y' '''3� a' r 14 -. .far r <br /> 2ND FLOOR: 3RD FLOOR: ;� i' <br /> 7o '2.o 1131 llr ie D -.x "- <br /> ESTIMATED CONSTRUCTION COST: ♦ -► --► '-► ctact 3 4 v' <br /> (Please round to nearest dollar) 2 _,,,:�-k_^_., _:.�_ r <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond lake? ❑Yes ' ❑No.• ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property?...k ..:MM.... ❑Yes f 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)...aoie., (d V 2 39 ..0.)0 :Yes ❑No ' ['Don't know <br /> 7. Is this to correct a violation? - ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —I. --o- <br /> 545-112{4/o8) - <br />