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ZONING PERMIT APPLICATION www.coun t �' SUPPLEMENT to,WebApp #_ <br /> fdane.com <br /> PROPERTY OWNER'INFO_RMATION: V'` CUSTOMER TO PROVIDE <br /> OWNER NA <br /> GGCA LLc ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3° 8`1 'PvLolOV- C \ St;' PY'1 G11Yc1\ \\\)\ S?S9O Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS - <br /> le 3 8 ) -4S c f c (,C [' Site Plan drawn to scale <br /> AGENT?INFORMATIOIN ':: . . . :-, ;CONTRACTORt JNFORMA1ION_ 4;;{, and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,.< a-1\1 Oovv g-kr c b o(n (IC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (-lass s i,-)tA,--(-7 P.1 ac\;\ <br /> (City,State,Zip) (City,State,ZIP) ❑ Setbacks <br /> Oak G �' \�1 53 S �PHONE PHONE ❑Site Plan approval from <br /> Lop$ 33 C (j 8 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> kIJ6,k. c:�S .c ci�c+ I• c°1,,T L Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION,' (http a//aecessdaneco,dane.wius/) : ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL t , - - ,asy�,� • 93 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> v-t S-61) '/4: 1//4: ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> 3 0 81 1QY1ok a\r- Lam. ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> i3'STAFF REVIEW <br /> PROJECT DESCRIPTION: �; �,� � �, � ,.� <br /> Qe C.K g ' nnmg i:31strfcr 'rt <br /> El This project is a new building or structure. ©� `ermlfttd Us '� i <br /> .12This project is an addition/alteration to an existing building or structure. 1 'e II <br /> SANITARY SERVICE: PERMIT NUMBER: © R Xal4Addr_es5 <br /> -FEWER [EPTIC °s new xis 1g) �` �' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) +; -s- <br /> -' F 4. <br /> -S1ho. 1 tristtac meet) <br /> AREA TO NEAREST SQUARE FOOT: -w '� �k s <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches). �`-�7 � �` ; <br /> BASEMENT: 1ST FLOOR: ( -galPiO{�tlUregi t � . <br /> 3 9'Y S$ ,, TOTAL SQUARE FOOTAGE j `: S1II i 65tur a c 4,, f y <br /> 2ND FLOOR: 3RD FLOOR: <br /> ir -'t <br /> G! <br /> D-Rel/1 }i O# t_ t�'SO <br /> ESTIMATED CONSTRUCTION COST: �r be .. - i" _� <br /> (Please round to nearest dollar) .' '" ♦ ♦ -4' $ I J S T` Wy � a Tfl7$` - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Lalo - ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? Lives 13No .❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Eares ❑No. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ENO : <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) Oyes llo ❑Don't know <br /> 7. Is this to correct a violation? Eyes �4 o . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -4 <br /> 545-112(4/08) . - <br />