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ZONING PERMIT APPLICATION www.countyo1danc.coiYl UPP,LEMENT to Web•App?- <br /> !PROPERTY.OWNER?INFORMATION - , .?. :-;4sk — r ,.. - i.A =.�.` >. . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> cr�-uy 4 D RA £Ll-/V i Zoning Status; CUP; <br /> WNERADDRESS (Number,Street,City,State,Zip) <br /> ,y/ Deed Restriction; CSM <br /> (o/D 2 k M' r01itifhd .R dl s AtiD icso,f) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (,OS 310-87 --e-e- /I,ort-r , cAcrrter&CT ite Plan drawn to scale <br /> *OW NFORMATIOk 1 :V 1; srt rCONTRACTOR"INFORtIATION yt:} aA and includes dimensions _ <br /> AGENT NAME CONTRACTOR NAME / <br /> CAT q.L ySr &US MO/ 4 "dr Site ' .n in ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s',tic <br /> 4/39 D///Q i- <br /> City,State,Zip) ` (c'ry,State,Zip) (� :etbacks <br /> - . Aloe Gro✓'e Pa- S3.'Z7 <br /> PHONE PHONE V ❑Site ' _n a•%oval from <br /> 60g-35r-326'2 applic.. •wnship. <br /> E-MAILADDRESS E-MAILADDRESS - <br /> aPe-x11140115 <br /> o4 V/44 'o. -3 Dfloerillans to scale <br /> PROERTY/LOCAION INFOtTON http,/accessdae.codaevus/) ? <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAG. e vation of property <br /> 0 U frontage drawn to <br /> scale. <br /> ER o k .S`/ 70V--( I Q= i c1 Ltcy I I / <br /> TOWNSHIP: - . SECTION: <br /> • ,/: - 'RA: ❑Drive ermits <br /> ADDRESS: (state, co ty, town) <br /> 6/Deo gP1-T-' 41 AV d . ❑SanI : its <br /> CSM• LOT SUBDIVISION BLOCK/LOT p <br /> 0. v(public :1 ate) <br /> PROPOSED PROJECT_INFORMATION . ST- 0:VRtVikiVA ; <br /> PROJECT DESCRIPTION: - , .,. - <br /> ADD(T'oa )4—Scc,cm )C c )� , a ,0J �1 <br /> a` s c 1 .44 <br /> . OThis project is a new building or.structure. gF,d, 1 ,e tit x <br /> This project is an addition/alteration to an existing building or structure. ` ‘ <br /> �,. �z <br /> SANITARY SERVICE: PERMIT NUMBER: __..E f= "` <br /> in.EWER . e.EPTIC ,__"� z ` te. �g-� S'L <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) _ ---� <br /> M el el Dodo -1e ° ., <br /> 3_ o aaid* tta . <br /> AREA TO NEAREST SQUARE FOOT -- ' `R <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ',V- �.r le�, <br /> O ear �� ' <br /> BASEMENT: 1ST FL(ZOR: N *Co 5 4r <br /> ' s 4 TOTAL SQUARE FOOTAGE ,l �� � B 90 �,^, <br /> cr <br /> 2ND FLOOR: 3RD FLOOR: L --..,42.2..f."-r E <br /> r�s.p,C .���5.'�4y.`�T¢ q "ter <br /> ESTIMATED CONSTRUCTION COST lr <br /> a�a , G E EeVe <br /> (Please round to nearest dollar) ♦ -4. ♦ --► -+ '� $ S � '�_ <br /> 4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes-' No.- ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes o. - . . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes • 1j1\10 . <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 EDN o • ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ©No <br /> • <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -4 -► <br /> 545-112 0ms) <br />