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ZONING PERMIT APPLICATION www.countyofdanc.com UPP,LEMENT to Web�App#
<br /> PROPERTY`OWNERhINPORMATION :N:za ; '�_ " ` K - C MC V
<br /> .�.-..- -_„� ..-�..._ ..,..-�__. .,.--ti��_ _ .z�;-;5�-r- _�i- r :�.�.r.._.�.--3.T .,!._✓c r�_�re�is�.:e:.- lilUS �IYILR TO PROVIDE
<br /> OWN r' M f `` .
<br /> �V VI rICAA • tO'PA If a I .Z _ [ zoning Status; CUP;
<br /> 010E5 ADD ESS (Nu ber,Street,CI ate, •p) �. D ed Restriction; CSM
<br /> ucYd ti� �� SAS�� V riance(# - )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / -
<br /> ite Plan drawn to scale
<br /> ,AGENTTINFORMATIOi}e-K NTI ACTORTA OR•I ONON , �y =; a d includes dimensions _
<br /> AGENT NAME TRACTOR) N ME $
<br /> 1 etCViC,L Ct7Vtc CiC ” ite Plan including location
<br /> AGENT ADDRESS mige.troR ADDRESS n g 1,24 . f well/septic
<br /> (City,State,Zip) (City State,Zip) Setbacks
<br /> Ve Yu V\a , 140.E S--3-5173
<br /> PHONE S.G El e Plan royal from
<br /> 6Q 0 _) �s i le township.
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> F oor plans to scale
<br /> PROPERTY/LOCATION O.0001ATIOt4 (http.Uaccessdane.co,dane:vin.us!)' 3: Elevation of Property
<br /> PARENT PARCEL N BER: CURRENTZ NIN ACREAGE:
<br /> ❑PARCEL ,j frontage drawn to scale.
<br /> NUMBER &0,1), -1, I ?w ,o R y, / �.
<br /> TOWNSHIP: - SECTI N' ` V^ ,
<br /> "�O (� I, '/a: v '/a%4:� ❑Drivew ermits
<br /> ADDRESS: (star , county, town)
<br /> •• I � rck�� \ i`e\ R , . - ❑Sanita •ermits
<br /> CSM: L• 1 SUBDIVISION BLOCK/LOT (.ub• , private)
<br /> PROPOSED PROJECT-INFORMATION : .•. _ - - f-" ST VI
<br /> PROJECT DESCRIPTION: , • , i_ t :':,� = `4 �E
<br /> �G GI\0 U t . 0 `C �`'� LF nn,o#D, me , i� .
<br /> This project is a new building-or-structure. .4- hi Vc& (00 'r 0 a p i a
<br /> Y
<br /> Age, 4 T Ified s .
<br /> This project is an addition/alteration to an existing building or st uC re. � t ,
<br /> P 1 9 9 �-�
<br /> SANITARY SERVICE PERMIT NUMBER: t, "t n 9" -�k `�
<br /> FIEwER . SEPTIC i.Tft:a- f ''i' .,
<br /> HEIGHT IN FE : NUMBER OF STORI S: (Not including basement) 4` _ '
<br /> �� f 3
<br /> AREA TO NEAREST SQUARE FOOT ¢' ep��
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -� ';.
<br /> BASEMENT: • 1ST FLOOR: D e r� e e, _
<br /> I, TOTAL SQUARE FOOTAGE: 4, ,,� °° ,; w
<br /> 2ND FLOOR: 3RD FLOOR: n/� z -c -a-. 1,0 . -1_,....,--vitA---
<br /> tea e1) )_-
<br /> ESTIMATED CONSTRUCTION COST '' V
<br /> �! E COQ 3 �'
<br /> (Please round to nearest dollar) '♦ ♦ ♦ i.�/ (1 G� T'-''''' ''''t.:-.. 1 - ..' =
<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 i5!1No •❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑No. - . -
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es • ❑Ng .
<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) ' Dies j o ❑Don't know
<br /> 7. Is this to correct a violation? [Yes �i o .
<br /> •
<br /> APPLICATION MUST BE SIGNED
<br /> - (Continue on Back) -9 -9. -Is
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