|
-1716.71GENIT INFORIMATI* ' '
<br /> CONTRACTOR NAME
<br /> I \i AGENT NAME eise.,,k, 466 ImproterleAt 4"1-'4- t fl osfitvveePnifasnepinticcluding loc
<br /> \/\\,° Tle)sY 4:Ecf,:(I (, -r'-'1/,.- - '- ---, J: 1 CONTRACTOR;ek6b--E ----
<br /> 1 ‘■:) rwAy't tp NI 11 6`..z6?_ silw„,- as
<br /> ----- — aSetbacks
<br /> R ;(City Stale,Zip, i
<br /> :City, ,te Zip)
<br /> 5.170 ,.-----
<br /> rit
<br /> sc"-- 4 ill YA NIN' -53,..S _ _.‘ 6101 WIG d 001 153------- - - Ej Site Pla0proval frD
<br /> ..,
<br /> t -
<br /> -PHONE
<br /> 60e -5'5,r-2/N6 __ .___ . appc,able township.
<br /> ---
<br /> E-MAIL ADDRESS ,'E-MAILADDRSS
<br /> • , itt,1 iv,i e,,vr,dse-rf„,,,s..,ver 0 Floorpiapls-fo scale
<br /> PROPERT'YAAICATION INFORIRATION (kettp://accessdane.co.danami.usi) 0 Elevation,affiroperty
<br /> CURREN I ZONING- ACREAGE
<br /> frontage drawn toca
<br /> 0 PARc 0 7/oSo -e- rn.- o22. -
<br /> --c R-1 DiPP iz-o lso o-,,i
<br /> NUM/ el2
<br /> TOWNSHIP — SECTION
<br /> 0 Driveway.permits
<br /> V JL..,
<br /> Yi: - 'WA: ii4V (state,deunty, town)
<br /> ..... ..._.
<br /> ADDRESS — , III to
<br /> 7 liemlasi a; _ _, sanit7permits
<br /> ,,,,,V LOT 2„....' !S :DWI'S!--N'--:, 1-- -;--' 1 BLOCK/LOT (publi , private)
<br /> I , . ,,,
<br /> PROPOSED PROJECT INFORMATION
<br /> •' .TAFF REVIEW
<br /> PROJECT DESCRIPTION
<br /> 64-C, , &, ,6'.
<br /> .. )Zening District
<br /> # ' ee . C7- _
<br /> This project is a new building or structure. :Permitted Use?
<br /> 74 This project is an addition/alteration to an existing building or structure. .-- ,
<br /> 1 J Rural Aires
<br /> I SANITARY SERVICE 7 PERMIT NUMBER'
<br /> DEWER 14EPTIC A) jhi (new/existing)
<br /> HETOHT IN FEET NUMBER OF STORIES (Not including oasement) .-
<br /> /0 I 1 D Wetlan oodplain/
<br /> ,
<br /> _ - Shoreland/(attachm(
<br /> AREA TO NEAREST SQUARE FOOT: /
<br /> ..,..--'
<br /> (Ou(side dimensions including unfinished area,attached garages and above grade decks or porches) r.--1
<br /> 1-1 ErosionCohigfperm
<br /> BASEM•N-I - ' 1ST FLOOR
<br /> J, TOTAL SQUARE FOOTAGE: 4, (slopes, ' turbance.
<br /> 1 . 7 filling/ cess)
<br /> 2ND FLOOR 3RD FLOOR Z--
<br /> (9'7 6 ..„-
<br /> .. J Review Location Sur
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) –* -0- -+ —' -* -II. $ En eii and available option
<br /> -,-
<br /> ./.(.......,-.....................--
<br /> MI e,/et. ..5' iiva r I
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des 12 o Upon
<br /> 2. Is there a wetland or floodplain on or near the property? ................._............_ DYes No [ Don
<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 No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> g
<br /> 6. Is a location survey required? (see reverse)...._...............,...................................._ Des No ODor
<br /> 7. Is this to correct a violation?
<br /> Des No
<br /> r APPLICATION MUST BE
<br /> 112 wo8) tjc‘ 7 j , (Continue on Back) -,
<br /> I 1411NT70wn erf kg e ni
<br /> I . DATE:
<br /> ieN1 eiS'eiis4 ' 4.7 l L
<br />
|