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ZONING PERMIT APPLICATION www.countyofdano.com UPP,LEMENTto Web•App;# <br /> )PROPERTY_OWNER"INFORMATION_. ,�z, Y �- ' 'i " t Y '- <br /> _ ._ .,.�_ .�:�,�• _ _,�- r :� --.. .�.-� T .. �--�_. � ,.�. �-_,:; CUSTOMER TO PROVIDE <br /> OWNER ME ` / <br /> OWNER L(KAteLA.1 n Zoning Status; CUP; <br /> OWN RADDRESS�g(Number,Street,City State,Zip) Deed Restriction; CSM <br /> D °�i✓ izt ifei -,e secr•a Variance(# ) <br /> HOME PH N CEL ONE `J E-MAILADD�E SS <br /> Q 1 / /" n Site Plan drawn to scale <br /> AGENT INFORMATION 1 ' -•< ,`.t r reONT1tACTOtt"INFORIiIATION tw ;y,y_a a- and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> , 57144. 5t re."0 7 bri n Site Plan including location <br /> AGENTADDRESS CONTR4tTOR ADDRESS of well/septic <br /> . 6.34/4.P r?se car <br /> (City,State,Zip) . (City,State,Zip) , ❑Setbacks <br /> 1 h l'It <br /> PHONE PHONE []Site Plan approval from <br /> S-7-C-"(ri — S"[2. ° applicable township. <br /> E-MAILADDRESS E-MAILADDRESS J C - <br /> [] Floor plans to scale <br /> At el c11 ! •. 'ALA f <br /> 'PR_OPERTYILORATION_INFORI(AAT lOM> (http,//ac�cessdane.co,dail.0*.u51)' :_. <br /> s- n Elevation of property <br /> PARENT PARCEL NUMBER: .- � CURRENT ZONING: ACREAGE: <br /> 0 VrA ER . ids- Z 5z- tad!- 3 4- 6 5+,r, frontage drawn to scale. <br /> TOWNSH�. SECTION: <br /> Z S / ❑Driveway permits <br /> �-�� 0147 1/4: <br /> ID%Y: <br /> ADDRESS: p ' <br /> / (state, county,town) <br /> 1 L.�e <br /> n Sanitary permits <br /> CSM: . LOT / SUBDIVISION BLOCK/LOT (public, private) <br /> O. ;1' • •b 4' .;t•r1 4 INI:I-1'7;111,LNIEel: - a ST R E <br /> PROJECT DESCRIPTION: s <br /> 5 <br /> / Z x /` - Jere <br /> e Al tax,1A / /6 A /Z /�.Q t 4, a Ai_,liC }7, � <br /> . QThis project is a new building or-structure. ItE�ed is• <br /> ;-W - 4 <br /> Vrhis project is an addition/alteration to an existing building or structure. '4�,-- Tom= _ - <br /> SANITARY SERVICE: PERMIT NUMBER: — a k '�=i <br /> EWER F-TEPTIC -"F.. *66' 6 -40$ <br /> SfT- ' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) '-",` <br /> - -/I`. 6_Ake °/F odd ota�tl. >r <br /> �Q arfd tta e` " <br /> AREA TO NEAREST SQUARE FOOT 9� ,73-'`-` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '' <br /> : o Ax, Xa r• eefi <br /> BASEMENT.' 1ST FLOOR: V <br /> s�• . 4, TOTAL SQUARE FOOTAGE _,1 <br /> 2ND FLOOR: 3RD FLOOR: t " -- <br /> .:y,YUe'�..nl�"S� "fir <br /> ESTIMATED CONSTRUCTION COST: - o - --t� F e <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ i /e 0 P x' & <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes'' • aDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Efres J'"0 .ODon'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? U'es Xo <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) res arc; ['Don't know <br /> 7. Is this to correct a violation? Dyes 0o . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —is <br /> 545-112-(4/08) • - <br />