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ZONING. PERMIT APPLICATION www.countyofdano.col�. - . .'.�'�
<br /> PROPERTY'OWNER'INFORMATION : t y r Y j _ ' C MER T �7p
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<br /> OWNER NAME /
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<br /> -e-' r 9- 49-&* V O. #S Sci c-�� ■ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,St Zip) ;
<br /> �y� D ed Restriction; CSM
<br /> b S le-4,11k 1 --0, C tar 6L ( $ 4 .T 53523 ariance(# )
<br /> HOME PHONE CELL PHONE U E-MAIL ADDRESS -
<br /> 661(''"123-41 = &et - 256-47251 S. a Plan drawn to scale
<br /> 'AGENt.NFORMATIO;Nt `�° A OI!IT a'CTO 6INFOR r T ONr 'r '
<br /> ._.. ..y.�� .,i��� C �►.���R., ��A�.,...,..r_�.�� �n;� a d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ...e 4,` Z•%.;;t A >7� }/"1 i Plan including location
<br /> AGENT ADDRESS CONTRACTOFA DRESS — o well/septic
<br /> 3 (93 GI{MLA 1.r
<br /> (City,State,Zip) (City,State,Zip) etback s
<br /> S'h,``�i"I` 4" 2 S LS 29
<br /> PHONE PHONE n to PI approval from
<br /> ( ° . • 1 ( 9 _ -7 1 4 - appli ble township.
<br /> E-MAILADDRESS E-MAILADDRESS - •
<br /> row b u. " c .. a� w4u.I,gt l00r plans to scale
<br /> PROPERTY/LOCATION INFORMATtOM*` (http,%/accessdane.co,dane vir7.us/) 3. z_i:;. Elevation of property
<br /> PARENT PARCEL NUMBER: • Q� C RRE ZONIN ACREAGE:
<br /> PARCEL❑NUM ER OCD{'t ' (�LI—[)?( ,H�(� " �, frontage drawn Cale.
<br /> TOWNS P. (� SECTIO
<br /> In��S�t ��� -___ � ,,,, s_ '/A: S ❑ Driveway rmits
<br /> ADDRESS ( , (state unty, t. n)�_N4 \ L/�F����/` `o 4 Sanita •ermits
<br /> cSM: LOT SUED SI N BLOCK/LOT ❑
<br /> 4 pub• , private)
<br /> PROPOSED PROJECT INFORMATION , - ,:,. , f STA R twat:t'
<br /> 147()—A i 4-1--cryl ..30), x a �� _
<br /> PROJECT DESCRIPTION: . ' � 1� � - -44
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<br /> This project is a new building"or"structure. a -.:4-14-
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<br /> This project is an addition/ Iteration to an existing building or structure. , f
<br /> SANITARY SERVICE: PERMIT NUMBER: a° ,i:
<br /> EWER EPTIC Ce N E i eg - i� -
<br /> HEIGHT IN FEET f NUMBER OF STORIES; (Not including basement) .`,F' -rE1
<br /> f �1 $° ° IB° 1'
<br /> s }' a t
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) '� - h- a
<br /> o B§ . ,.e° t ..- i--
<br /> BASEMENT: 1ST FLOOR:
<br /> - j, TOTAL SQUARE FOOTAGE: ,l, .z- 1 !
<br /> 7� aq ' - T',
<br /> • . . - -- ?° --,_;,-,.,7=t4----:. ,
<br /> 2ND FLOOR: 3RD FLOOR: ` '
<br /> • �evi @-a •e13 y_.,----,
<br /> ESTIMATED CONSTRUCTION COST: Q -' ;� 9: i c @ e e m e�
<br /> (Please round to nearest dollar) ""� ,--■ '-4. ♦ '-'1* "� $ q boo
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ) gNo.• ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? QYes No .['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Yes ['No. _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes : ®N .
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes o Don't know
<br /> 7. Is this to correct a violation? ❑Yes [p�No _
<br /> V APPLICATION MUST BE SIGNED
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