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SPPLEMENT to Web App#ZONING PERMIT APPLICATION www.countyofdanc.con U <br /> r s CUSTOMER TO PROVIDE <br /> °PROPERTY-:OWNER"INFORMAT10�11 -ti,1��:�t.����. -_:�o e�: `.�:�,�,-�.�,.----�._.� ,_,�' <br /> OWNER rrNAME <br /> 3e.-ttt'e y A t-l+tul a i n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Li 567 °Ate- PA-X-16 gd . " Variance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS - <br /> (ap$ ao q 3c/35 Jc tnnlvcrsor\ a VA6° • c I I Site Plan drawn to scale <br /> AGE NTl1NFORMATIO�!IF„1„ a MMMT.wtir rCONTItwACTO INFORiI%gTION W _r.-._ :c and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> • applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS - " <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFOJtMA'FLON (http//aecessilane:co,dane.vin.us i ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER 0 712 - 053-8oaa- 2 41 -Y©'4 <br /> TOWNSHIP: - SECTION: <br /> /'E7e46 40 S '/4: 1/4,/4: ❑Driveway permits <br /> ADDRESS: (state, county, town) <br /> 567 0 9K PHI K Pc) - ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION , - _ `4 751 R � ,, <br /> PROJECT DESCRIPTION: Q —_- : : <br /> ReP)CLC-E PlGLA 1712- .5146-1() .111, . m i <br /> This project is a new building or structure. R.IMta fitted :s �d <br /> ❑This project is an addition/alteration to an existing building or structure. m 3 <br /> SANITARY SERVICE: PERMIT NUMBER: XI 9 e_e �r <br /> . FIEWER . rEPTIC .I <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) , ,1 ` �- g <br /> 46./ -. ,-V- <br /> �,. / . I a la otroee o i .r-2,-A .-„-g- <br /> _ ; <br /> hA aift :° e <br /> AREA TO NEAREST SQUARE FOOT: ,t=om' <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) , �. <br /> ..:C'��o p; a r� �e tom- <br /> BASEMENT: - 1ST FLOOR TOTAL SQUARE FOOTAGE: ,4, @8 <br /> , 1 r <br /> _ . . . ""sU fi t.} <br /> 2ND FLOOR: 3RD FLOOR: /J� /L}, ,� � ' �-` �_.„17-&' <br /> ESTIMATED CONSTRUCTION COST: 'i @ E C P.1 ��� <br /> (Please round to nearest dollar) —0. '-'I. ""� ♦ --► --1> �- --� A <br /> 5!000 c7 ,— - <br /> • <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? Elves Jlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? I]Yes ❑No. _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years'? ©Yes • ❑N9 <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 JNo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes �C]No . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> • (Continue on Back) —► --► —Is <br /> 545-112{4/O8) - <br />