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f .SUPP,LEMENT^to�Web�APP ki <br /> ZONING PERMIT APPLICATION www.countyoldne.com .w_,.'_.. - <br /> Y <br /> PROPERTY'OWNERIINI FORMATION -a, _�_ z ,. , r= ; Y-4;s r ,y r7f-:vY CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1-;1-C' /14q q--- /tia r41/ 'G t- 0 �/- n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,city,State,Zip) <br /> /gr? � '/ 0rlo A— Deed Restriction; CSM <br /> HOME PHONE ,`CELL PHONE E- Variance(# ) <br /> �'E-MAILADDRESS _ <br /> �� ��y� G,� �� 1 J Site Plan drawn to scale <br /> 4AGENT}INFORMATI010_" V l; -5„ t (CONTIiACTeltf1NFOR11Aq TION ,__,_y _, ni and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE n Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - <br /> n Floor plans to scale• <br /> PROPERTY/LOCATION II0FOjtIII ttliciN> (http cce <br /> l/assdane.co4dane iw is/)',".'M_:=vi n Elevation of property <br /> PARENT PARCEL NUMBER: • CURRENT NIN ACREAGE: <br /> L I NUMBER D6!/1 q/boo ,c, f t-e7, 3 G frontage drawn to scale. <br /> TOWNSHIP: - SECTION: <br /> P1 ec sat.. S". 4( ,4. %I : ill Driveway permits <br /> ADDRESS: <br /> '�'^� (state, county, town) <br /> /NS” --1:pfi16,, 6.1 0 pi b <br /> CSM: LOT SUBD(7ISION BLOCK/LOT n Sanitary permits <br /> (public, private) . <br /> PROPOSED PROJECT:INFORMATION -. -c- ' . X 1§.1talREYIE 1 <br /> PROJECT DESCRTION: 94 <br /> Sri trat -0.6-t-ttiitteiemPp- .--At <br /> �G}This project is a new building or structure. �-� :i '- <br /> �P rrrtl d Us lei <br /> This project is an addition/alteration to an existing building or structure. -- -n 2,.- <br /> SANITARYSERVICE: PERMIT NUMBER: E. {1R T ' _-e5 2 _ <br /> " ewe s6_ .� - -,u4 <br /> EWER EPTIC a � � s—;,:'-}:- <br /> HEIGHT IN FEET ( t� NUMBER OF STORIES: (Not including basement) %x•15:1; :±� <br /> r �• / C- 1 e Ia'i�$/F oodd.pl in- 1 <br /> AREA TO NEAREST SQUARE FOOT: - ? 2 tttko iae.raq. <br /> — z,w <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) :- °� -de .,.;. , ? <br /> BASEMENT • _ 1ST FLOOR: ` it*ps1 a,z-R, r per l <br /> 6 �- <br /> - 4, TOTAL SQUARE FOOTAGE: 4, , �LioES �t=5, C , <br /> 2ND FLOOR: 3RD FLOOR: i�I_i* ao-ssS, - <br /> -4-e_ <br /> • <br /> q3e e 002n�S1 _ <br /> ESTIMATED CONSTRUCTION COST: <br /> Please round to nearest dollar ♦ "� "♦ --0. "♦ 'ale ° r© IS M °1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes P No.• flDon't.know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes INo .❑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? Lives gNg : . <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) Lives JNo • ❑Don't know <br /> 7. Is this to correct.a violation? ['Yes NcNo <br /> APPLICATION MUST BE SIGNED <br /> • • • (Continue on Back) -•0. --0 —s <br /> 545-11 2{4/08) - <br /> • <br />