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UPLEMENT o Web App#ZONING PERMIT APPLICATION www.countyofdano.com <br /> PROPERTY OWNER INFORMATION �" ;r-1 , � �n -,. _ rNyN, „__ _ ,_,; :�,-- CUSTOMER TO PROVIDE <br /> OWNER NAME - <br /> JcV c Jti G in-j SL h 4q f n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - Deed Restriction; CSM <br /> -7 2.3 4, L i h s. l c y [.,.- - S'f u kk C r ij WL .5.3 511 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> (fOg^ Sf -7Z3)' I 'site Plan drawn to scale <br /> Oitit tlijklitMATIONMA%.. ,t2 CONTRACTOILt INFOR IATION .- _ ; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 141 /1 PDDI! r SW S n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ooaoXysr(, <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> M o44 1112 Iv .. 51 V1 <br /> PHONE PHONE n Site Plan approval from <br /> co D r – f Q 3-3 O`( Q - applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - <br /> f hy,a..I E. t✓'4 'nab . cc--v1 ❑ Floor plans to scale <br /> `-PROPERTY/LOCATION INFORI)AATIOMr.(httPa/accesiiiane,co dane:vu1.as/)' " 1-1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT-ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER OqO'!- Is,-(-(4$/5—D ra-'- 1 0. 539. <br /> TOWNSHIP: SECTION: <br /> • <br /> '/<: '/4'/4: ❑Driveway permits <br /> ADDRESS: (state, county, town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT_INFORMATION `` - r'-'SI �, RkVIIEM <br /> PROJECT DESCRIPTION: '° ,T€ T1 . <br /> i to <br /> JS' )( WO ingrcJ4� peel ,1 er e,,! ,ai <br /> . ®This project is a new building or structure. - ;,err-nlffed js 1' `-;-. <br /> ❑This project is an addition/alteration to an existing building or structure. i . <br /> SANITARY SERVICE: PERMIT , ! a -s P" ,t- `: i .._InEWER r)EPTIC s- � <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) &,a - { - <br /> -i e) 13o/Peeeo t °**s_ <br /> AREA TO NEAREST SQUARE FOOT <br /> v �4-� <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .-'"' - . 4 <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE 4, " 'WO 4.-L - <br /> Sf a - � Ij <br /> 2ND FLOOR: 3RD FLOOR c ; <br /> .^gt a }4,S„ Z • <br /> ESTIMATED CONSTRUCTION COST: l = ii <br /> -► '-r. -► -i -► --r $ C 3 O 0 0.6 b F' t-, <br /> (Please round to nearest dollar) J �.���� x:_ ,, <br /> • <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des � [XjNo.• ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes OND. . . _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes DO <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) Elves o - ❑Don't know <br /> . . <br /> 7. Is this to correct a violation? Elves No . <br /> • <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► .4 <br /> 545-112{4/0B) . - <br />