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ZONING PERMIT APPLICATION www,countyo1dane.cofn = UPP,LEMENT to Web•App#2 <br /> IiROPERTY;OWNER'INFORMATION r ;4 •rI,_ r=,_ ; __a V - M.; ,- CUSTOMER TO PROVIDE <br /> OWNS NAME <br /> Ch IS , K K I sf t h e we(.L S Zoning Status; CUP; -/ <br /> OWNER 0 SS Number,Street,City,State,Zip) Deed Restriction; CSM A UBRed . L V ' <br /> Variance(# ) <br /> HOME PHO E 1 Lt. Ot ? E-MAIL ADDRESS _ <br /> NI" PA (pd idie b- 3-.)5 r i 1 cone ekert m dil.c4 x Site Plan drawn to scale ,i & <br /> .AGENT=INFORMATIOAIt„.. ''' tired sCONTRACTOteINFORMIgT10N `y a and includes dimensions <br /> AGENT NAME f j « CONTRACTOR NAME A <br /> Site ' - •:- •ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • ell/sep is/' <br /> (city,State,zip) : ':, (city,state,zip) 11 Setbacks 6 3/3 0 0/0 <br /> PHONE PHONE Site Plan approval from <br /> - applicable township. 4-- <br /> E-MAILADDRESS E-MAILADDRESS ��( <br /> il��Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION> (httpJ/accesdane,�co,dane4vl►i.usI -i-Oki levation of property <br /> PARENT PARCEL UMBER: .2.IJ CU RENTZO,N�G: ACREAGE: �� <br /> El NUMBER 0 ( 8 �O7'i-231(-8A-I A _ 1 I, ' ( 3 frontage drawn to scale. AV <br /> TOWNSHIP: n SECTIO : <br /> rU l( /;g r t�R Uye .Z-5 ,4: •s E IRA: N F r� Driveway permits <br /> ADDRE C (•i (state, county,ail <br /> X 82 Heed l ( ) Orerf- 1( j, -&/ 93`3 <br /> CSM: LOT Z - - , /� Sanitary •- nits <br /> (public .,tb <br /> , , eta <br /> PROPOSED PROJECT_INFORMATION .-'% =`' 'ST P•_:FIE—I:_ * _ <br /> PROJ' Dt�CR�PTION: ` `� • / "f' 1� s <br /> = ti <br /> • �This project is a new building or structure. /v a L •ve S �c� S �..c� -` F lit..y f 4 ' <br /> P J 9 ��� ernlld s -�- ' , „ <br /> ON his project is an addition/alteration to an existing building or structure. y a ' ', <br /> PERMIT NUMBER: �� <br /> e2 <br /> ■- wiz'-,.4 ilr�`� r' <br /> HEIGHT IN FEET j' NUMBER OF STORIES: (Not including basement) 3 - ,=1 <br /> r ' �, if Geo <br /> AREA TO NEAREST SQUARE FOOT: ' .-• ` kr B A ��_�� <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _,.• '� -* dev ; <br /> BASEMENT.' A 1 ST FLOOR: 'D B I'0 ,1 t _ <br /> N� O j TOTAL SQUARE FOOTAGE 1 . ° xP C e,, / <br /> 2ND FLOOR: 3RD FLOOR: 10 t i .- ' j, "f <br /> ,- Tw f -s <br /> ESTIMATED CONSTRUCTION COST _ -Arta"aii e f <br /> (Please round to nearest dollar) "'� "� "♦ ♦ "� "'•� $ ���, 6 0 �� . --m,� - , : <br /> /3/5=/ill <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ' �W o-- aDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? [—Yes OjNo .QDon't know - <br /> 3. Have you talked with the township about your project and are they in agreement'? f Yes t o. .• - . . _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes o • <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 ' o - QDon't know <br /> 7. Is this to correct a violation? QYes ►El o - <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0. —► —Is <br /> 545-1124/O8) - <br />