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<br /> ZONING PERMIT APPLICATION wilvw.countyardane.com
<br /> PROPERTY'OWNER"INFORMATION,_ ;, ::`f ,„: -�«_,�-; ._��.�-�� r�`�� .� - CU.TOMER TO PROVIDE
<br /> OWNER A"E
<br /> ,(�U/ !�-e ( ' Z ingStatus; CUP;
<br /> O Igki-Filiaoli.
<br /> R ADD SS umber,S ret et,Ci ,Sta Zi C ry, Zip) eed Restriction; CSM
<br /> c 1 i) c)()VI- tSe tk, f ) rot 6, ari nce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> ,I'-7/,-0o, Lf i L4 _cyt 4,OctVer 4 6 Am Si e Plan drawn to scale
<br /> 4,14iiitiiikiitilAtIONTSWIMMKg r¢ONTItACTpitsINFJRMV10N n { a d includes dimensions
<br /> AGENT NAME CO TRACTOR NAM
<br /> 660cAct�- •use Lutr4Us n Ite Plan including location
<br /> AGENT ADDRESS CONTRACTORA DR U well/septic
<br /> well/se tic
<br /> 0 I I? 0T S v 64-.
<br /> (City,State,Zip) (CI , tate,'ip) Setbacks
<br /> , O 1,504 LOi , $ 3 13
<br /> PHONE PHONE ❑S' e Plan -:Grovel from
<br /> -0232 - 75f?600 ..plic,Y?etownship.
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> 6C$-tee A
<br /> Sc4 c? C.oD•Sev.)c• 5, 11 Flo'-r plans to scale
<br /> `PROPERTY/LOCATION INFOJiMAT_ILONp:(httpa/accessdane co,dane:WMisC
<br /> PARENT PARCEL NUMBER: • CURR TZONIN ACREAGE: , -vation of property
<br /> Ell PARCEL NUMBER D0o u I0,3 O I - , rontage drawn to sc .
<br /> TOWN IP: SECTI 1 n)
<br /> 6)( v-,,e. I %.: '" E '/4'/4: KJ ❑Driveway pe Its
<br /> ADDRESS: , / (state, nty, tow.
<br /> 61,-11 V� �I �� • AA ❑Sanitary • rmits
<br /> CSM: LOT SUBDIVISION a BLOCK/LOT I •ubf-, private)
<br /> rfi'SCISAI e r^ r ^ 0'4
<br /> PROPOSED PROJECT INFORMATION ` ,, r St 0fRI= fV -
<br /> PROJE TDESCRIPN: L ,_ 2,'
<br /> 1 '�
<br /> A. • Vt a�' I�e 0F0 f! r e , °,Cd .r3 "`. -•OT •' project is a new building or structure 4;i r effij Eed '?
<br /> This project is an addition/alteration to an existing building or structure. -''' � __ , -k
<br /> SANITARY SERVICE: PERMIT NUMBER: l9) 7,,,,,,P.:, 2E114_ = x
<br /> . F-TEWER . EPTIC J O - © O / ��G ' 9 g
<br /> HEIGHT IN FEET O / NUMBER OF STORIES: (Not including basement) �°, - --X- "$ .�. +F
<br /> �e
<br /> AREA TO NEAREST SQUARE FOOT °- ' . r _- ,.
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) >_ ."gyp _02; 1
<br /> I D e�, • ,°
<br /> BASEMENT 1ST FLOOR: �+ µ � �
<br /> 7� ,, TOTAL SQUARE FOOTAGE: 4, ` x` °°c i�0. ;l • fi
<br /> • ,£�'-'�� o �'+ 1�+�"rat �..
<br /> 2ND FLOOR: ` 3RD FLOOR: _"— - T� ,' "t-1/4.5
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) "'� ,-' "o. ♦ "♦ '"� $ G;?VI` 601 off'I?0 i 4111 g P� '
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes"' 7/.,o-• NDon't-know
<br /> 2. Is there a wetland or floodplain on or near the property? Dies 0 N .Ebon't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Wes U ■ - .
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 01'e • ffiNg .
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blank if none)
<br /> 6. Is a location survey required? (see reverse) " es ONo • 23/Don't know
<br /> 7. Is this to correct a violation? Elves llo
<br /> . -(..(4-' �i APPLICATION MUST BE SIGNED
<br /> • ( � �. • (Continue on Back) -* -S -Is
<br /> 545-112(4ro9) I ..J.�� -
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