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UiPLEMoNT to vi eti Apprc-- <br /> ZONING PERMIT APPLICATION www.countyofdano.com - a _,.___.�.-, _.--r _ _ <br /> _., T41f OWNER�INFO MATZO '=:�%�� ��w � <br /> ROPER � -� :�; --_- � <br /> x *?? �z�f , :4 ?ar '? =, . r CUSTOMER TO PROVIDE <br /> OWNE NAME <br /> ',1 <br /> Jinn `i- 0OYjhik l�)n i I Zoning Status; cu <br /> OWNER ADDRESS (Number,Streetf ity,State,Zi ) Deed Restriction; CSM <br /> •&-f (.r• YY1.QYVt•-4jd KOda i! r I LL)) �3'-_:3.3,-/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL DRESS _ <br /> (40;5-7 SI 32,04- 667Ana. lil5G0ir.t $(6tizte ,Me4-- I I Site Plan drawn to scale <br /> 410ENJ1NFQRMATiOlN �s Z4 5._4� 4,C ONTkI000I00.:04 ST N _ a,- and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 00 Ra (c 1 I Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES'S of well/septic <br /> affi s, .'c .)1(1 1i :r,. <br /> ty�tat <br /> (City,State,Zip) (Cie,zip) n Setbacks <br /> PHONE cJt t kJh u)) 6J�C�'e <br /> PHONE `J n Site Plan approval from <br /> - <br /> (Pa 4_Iy-C\ applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS - . <br /> e aLl, 140 L C n Floor plans to scale <br /> PROPgRTY/LOR+ATION IAiFOj tI ilit tiVahtfiii cessa iVeli i0iiiiv SlyrA <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 1--1 Elevation of property <br /> 111 NUMBER �1 frontage drawn to scale. <br /> NUMBER 65♦'a,-09i-IC -O 2- I L <br /> TOWNSHIP: - SECTION: ,1lai 575�it/ Rl2 <br /> b� 5/E ,/: /C IA c ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT n Sanitary permits • <br /> c% ' td (public, private) <br /> PROPOSED-P ROJ ECT INFORMATION :Y ,sy , Was YAVViRE ITEIN '`•PROJECT DESCRIPTION: -�-y5 '" - <br /> T4Z/Y,.Q e rl3l'V e:h?Ak � 1 611} 6 IS IBC--11--77;.-^„-''17•1-.:1--: <br /> 4 . �. <br /> • [h'�his project is a new building-orstructure. $ G <br /> Permit��edaUtt Ft <br /> , . ,L <br /> This project is an addition/alteration to an existing building or structure. £_- _ =1„a <br /> SANITARY SERVICE: PERMIT NUMBER: � a XeSS <br /> . FEWER . �I� PTIC _ �. Sri•1i vsZ <br /> y_4.-T'.a¢'o-'a°'-._ _-, _' vim-: <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> � _ — _ -�� =`� �= <br /> . . - A !� :_..ejar ae i ki =i <br /> AREA TO NEAREST SQUARE FOOT s r _ - - <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) "� � <br /> BASEMENT 1ST FLOOR: s-t$� C Lfoe _6 ,ttLyT62�Z62—'5, <br /> �A/y�/�' s�Y)�-��f�.� j, TOTAL SQUARE FOOTAGE: ,�, n� <br /> 2ND FLOOR: 3RD FLOOR: 6,F(2 _� _. ,., _'�` <br /> S <br /> �� m e371Q- nl araj .� _�- <br /> ESTIMATED CONSTRUCTION COST: , -. As vo <br /> ((Please round to nearest dollar) - -;3 �_e e o <br /> �U� Ott �—� �.�===g •• -.,; <br /> . ir . WI <br /> •1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ' �N -- flDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes to .❑Don't know - <br /> 3. Have you talked with the township about your project and are they in agreement'? Ej es ❑No. - _ <br /> 4. Has-there been a zoning permit issued for this property in the past 5 years? ❑Yes [►�No . : . <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 ❑ • adDon't know <br /> 7. Is this to correct a violation? ❑Yes IUNo <br /> • 31'0 . APPLICATION MUST BE SIGNED <br /> • (Continue on Back) . ♦ ♦ ♦ <br /> 5.45-1120/08) . <br />