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ZONING PERMIT APPLICATION www.countyofd E7U L'EMENT to}Weti%/IPP <br /> �rt�.com <br /> }�`,ROPERTYrOWNER3INFO,21MATIO F. '51-2- :;,.am:: - - - <br /> �.: = ,� ,vim r ? ss i€` � CUSTOMER TI O PROVIDE <br /> OWNER E ' `- +1 <br /> OWN R DDR S (Number,Stre I,City,State,Zip) Zoning Status; CUP <br /> 3/�� `�/eP�s- / I <v� /� Deed Restriction; CSM <br /> �/ / l .J ri �),7e � a Variance(# ) <br /> HOME PHONE CE L ONE ,E-MAIL ADDRESS <br /> ' 07�-5_x''7 6.Jc/cir 3a3e-Z;� c-Av <br /> �AGENT��INFO�RMATIO�;���� ���x�f°�"""'� �""°"'�"` � �- �- -.�, � �Site Plan drawn to scale <br /> � : . �CONlbri O t"INFO _TI.ONM and includes dimensions <br /> AGEN�ME CONTRACTO N E <br /> �// — ® n �r � 6�/? �!' n Site Plan including location <br /> AGENTADDRESS CONTRACTOR ADDRESS of Well/septic <br /> (City,State,Zip) (City,State,Zip) . <br /> Setbacks <br /> PHONE PHONE 17 Site Plan approval from <br /> - applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - . <br /> I t <br /> ;;PROP RTYILOCATIONt1 i'FO t A l0 1 A-tdoVi��fi , ;,-5-. . ° <br /> I-1 Floor plans to scale <br /> - �_��.� �(htlp;Uaecess�ane.cosdae�.ri.us/raff•„�: n <br /> PARENT PARCEL UMBER: CURRENT ZON G: ACREAGE: I 1 Elevation of property <br /> 1 PARCEL 0/y�a�o ;,�I_,cp 6 J , ' / frontage drawn to scale. <br /> NUMBER 3 l . <br /> TOWNSHIP: - SECTION: <br /> (jam/�C /. ,/41/. ❑Driveway permits <br /> ADDR /�/ q �j //A � (state, county, town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT I Sanitary permits • <br /> (public, private) <br /> PROPOSED:PROJECT INFORMATION „ r § - <br /> = SYFRaiEN <br /> PROJECT DESCRIPTION. - � _ P , <br /> • []This project is a new building or structure. • -� ,2-. " <br /> nThis project is an addition/alteration to an existing building or structure. r s <br /> SANITARY SERVICE PERMIT NUMBER: • . -- -'' 9e>es — <br /> r)EWER - F.—SEPTIC Q `ki= <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) '1`^ : = F <br /> . . Q 13 o t OQ_d t� <br /> AREA TO NEAREST SQUARE FOOT: <br /> o ;3t = tac e` er <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - `:: : i ?:y`-=-2 <br /> BASEMENT: - •D.I e3r•J=R <br /> 1 ST FLOOR: <br /> — <br /> 4, TOTAL SQUARE FOOTAGE: 4, ,„ o o 5, 35 LT7.. oSC..7 <br /> c•� 'rs,r 2ND FLOOR: 3RD FLOOR: L �I C <br /> . <br /> ....-,.-_-.---.--„-..4.--.1...,.....-,.-_-.---.--„-..4.--.1...,.- --w-.- ` <br /> ESTIMATED CONSTRUCTION COST ® v.�y� a i- <br /> (Please found to nearest dollar 4 4 —► —► —► --> " <br /> .d .,�-:de,e a t P.1 7- -fi r: <br /> ) '±rte �; _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' No-• O <br /> O Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? []Yes ENo .ODon't know - <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ONo _ <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? DYeS : ONO • s <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) . EYes ONo []Don't know <br /> 7. Is this to correct a violation? DYes QNo <br /> • <br /> Y!` . APPLICATION MUST BE SIGNED <br /> • <br /> 545-t1e-(4ro6) • (Continue on Back) . -4. —II. -0- <br /> . <br />