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ZONING PERMIT APPLICATION www.countyofdano.com 4 uPp >EnneNT to web.np }# <br /> PROPERTY`OWNER INFORMATION - . �,_�; ; 5 Y ,�z. ;mot - Mhj ' x `� ; CUSTOMER TO PROVIDE <br /> OWNER ME <br /> e Tj . e . 3/-a-ti+� . <br /> OWNER ADDRESS ((Nmber,Str t,City,State,Zip) ing Status; CUP; <br /> 2 Deed Restriction; CSM <br /> HOME PHONE 4 CELL PHONE DI& E-MAIL ADDRESS <br /> Varia e(# ) <br /> 6,02 835'8 570 (Qog(Pcl'8 3(F a,(- 8041re10 e. ,f p•hov, e3,-,--I Ite Plan drawn to scale <br /> AGENT IINF ORMATI01,, °` _ zf .. 'g4 Igt g CONTRACTOR"INFORI IgTriffM4M and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site P . luding location <br /> AGENTADDRESS / CONTRACTOR ADDRESS of w S tic <br /> (City,State,Zip) (City,State, ' tbackS <br /> PHONE PHONE ❑Site PI approval from <br /> - ap 'cab township. <br /> E-MAILADDRESS E-MAILADDRESS - <br /> FI r plans to scale•PROPERTY/LOCATION INFORMATION> (httpa/acce.sr<laine.co,dane:vus%) - �-% <br /> PARENT PARCEL NUMBER: .- CURRENT ZONING: ACREAGE: E ation of property <br /> 0 <br /> PARCEL s� rontage drawn to scale. <br /> NUMBER oc/0 - ogvi l o—S I—.— • <br /> TOWNSHIP: - SECTION: <br /> IA: ,/4,/4: 0 Driv ay ermits <br /> ADDRESS: <br /> (state, unty,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanit_ :- mits <br /> (pub• , rivate) <br /> - LI O {&^.1 - .,r, 9 <br /> PROJECT DESCRIPTION: gy r- -� <br /> i.elc,,, 40 01'-‘ e,-)j. (314 sc. ,1K--• 11 This project is a new building or.structure. �e � " <br /> ❑This project is an addition/alteration to an existing building or structure. m3 w <br /> SANITARY SERVICE: PERMIT NUMBER: R :6,,,' <br /> I ,, `A @ � c` .�` <br /> /SEWER r)EPTIC La� Gy1V ..en , `- .1. <br /> HEIGHT IN FEET NUMBER OF STORI (Not including basement) <br /> • Sipt 13 � �e € <br /> f4 �zy a et, <br /> AREA TO NEAREST SQUARE FOOT 1,- (- <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) . T s -'. <br /> - "'�`�, `�' p ��5r e_ e env ' <br /> BASEMENT: , - 1ST FLOOR: 4, - ., <br /> TOTAL SQUARE FOOTAGE: r o o T pa v n <br /> � _ i. <br /> 2ND FLOOR: 3RD FLOOR Q F . ;., <br /> . / . / <br /> ESTIMATED CONSTRUCTION COST: 3 , " P; <br /> (Please round to nearest dollar) "+ '" ♦ ♦ —! "'1* ( j r � . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ElYes END.• (Don't-know? <br /> 2. Is there a wetland or floodplain on or near the property? QYes fNo .ODon't know - <br /> 3. Have you talked with the township about your project and are they in agreement'? 'Yes ONO. - <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efts 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) res ENo EDon't know <br /> 7. Is this to correct a violation? - JYes JNo - <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —t► —0- <br /> 545-112(4/D8) - <br />