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ZONING PERMIT APPLICATION www.countyoidane.cof91 `SUPPLEMENT to Web App;#
<br /> PROPERTY OWNER INFOR..MATIONr -fiKi. 81,U ._ _ T 4. r s � CUSTOMER TO PROVIDE
<br /> OWNER NAME /
<br /> 5, c:,.. K,4 L.."Ot.,o" �v oning StatusiCUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> °I av l Cw 5)∎...;)-cl) L.,c.,...-c__;. Azi uc2...? Variance(# )
<br /> IJoME PHONE CELL PHONE E-MAIL ADDRESS be 33% 1,-l14 4013781y?y -
<br /> �_._. _� �, t- Plan drawn to scale
<br /> AGENT'INFORMATION,1..` . � „ tire` C_ONTI ACTOR"IINFOR$IATION < -; ., a- _ I d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> J 3-.ZLv Si Plan including location
<br /> AGENTADDRESS (3 CONTRACTOR ADDR well/septic
<br /> .- 3;,/t t,,„,,,t,L (,,,,i)
<br /> (City,State,,Zi ) , (City,State,Zip) 4etbacks
<br /> PHONE J PHONE Po fr
<br /> (L t --7-1--7-1 2 6. 8 Site pplicable lan township.apprval om
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> --CJ46-'..)14's .f,.t,„t-5 . 6.4A- j v.sL,•61, .2-; (.,�1.N.,401",e)_cot.. /
<br /> loor plans to scale
<br /> PROPERTY/LOCATION INFO)MATION>,_(http,I aacessdane,co.aane1 i.a01 h
<br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREA E: - levation of property
<br /> PARCEL �/ �i y� / , / 0.75 frontage drawn to scale.
<br /> NUMBER 01L7 --3Z` -gizZ-D A v A '— ( "I Ac-
<br /> TOWNSHIP: - SECTION:
<br /> , ,/,/4. gDriveway permits
<br /> ADDr. ,A1‹,L,
<br /> : I s - - •--• town)
<br /> CSM: LOT SUBDIVISION BLOCK/LOT Ivry permits
<br /> . )2. t4.41.%.,i4. • 4 I a • blic, private)
<br /> PROPOSED PROJECT INFORMATION = - �a �-„ rv.: �°
<br /> PROJECT SCRIPTI 1 hit✓G �� � � � .,vk
<br /> i°t' o C 3r �r i 1
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<br /> his project is a new building or•structure. 4 ��, I dr 4F ”
<br /> ❑This project is an addition/alteration to an existing building or structure. a = �' `
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<br /> 4r 9 SANITARY SERVICE: PERMIT NUMBER: -. - .. :�,k
<br /> EWER PEPTIC ;v s �, x - &4t '
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> �a vl � la•_ oClo in
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<br /> AREA TO NEAREST SQUARE FOOT s � ''' '-
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) P 7-, � �r. , r 45 s � o es e� e t• {�j ��;
<br /> BASEMENT; - 1ST FLOOR: c�Cp s �--..42 TOTAL SQUARE FOOTAGE: @
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<br /> 2ND FLOOR: 3RD FLOOR: ..
<br /> 1, 'uUU - - - 1t TISATT--A-44:qtliz,---Wat--
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<br /> e JI .
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) -► --► -i -0. �� � ¢ _ e tr7= :
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? []Yes ' El1o.• fDon't-know
<br /> 2. Is there a wetland or floodplain on or near the property? E Yes Espo .[]Don't know .
<br /> 3. Have you talked with the township about your project and are they in agreement'? E es ❑No. . . _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years'? es No •
<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) ❑Yes o • E]Don't know
<br /> 7. Is this to correct a violation? - []Yes lo _
<br /> • 4 L� )3 • APPLICATION MUST BE SIGNED
<br /> 1'' '3 (Continue on Back) -+ -4. -►
<br /> 545-142 j4108) -
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