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ZONING PERMIT APPLICATION www.countyofdVane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION ( CUSTOMER TO PROVID• U14•OWNER NAME <br /> QOG & r `t ❑ ZO •OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restrictio , 'SM Rte' <br /> 3848 ts 14 21NcP smQ (Z..)O . , ) �e , <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (p.:7(Q - ' . 4, . ,6-57‘5-- 1 ScX3 al •to Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Pla . uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we sep • <br /> j <br /> (City,State,Zip) (City,State,Zip) ba <br /> etcks <br /> .. <br /> -'' <br /> PHONE ' PHONE ❑ Site PI apKoval from <br /> • e wnship. <br /> E-MAILADDRESS E-MAIL ADDRESS " <br /> ❑ loor Cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.d i - . ') levatlon of pro <br /> PARENT PARCEL NUMBER: CURRENT ZOp NG: ACREAGE: p <br /> ❑ NUMBER Cri I t-2,4 1 —qc„e/(,- ct A-2�a`� I S.ct frontage drawn to scale. <br /> TOWNSHIP: SECTION: J <br /> �'-4 IA: N 6 141/4: , riv ay its <br /> GRE iT (o �° 120 U F (star , o ,town) <br /> ADDRESS: <br /> 2 8)`i 9 L , Z/lH(o s--94X2 K.i) D.frx6EL4l . �" .S-3-,i3 I ani rmits <br /> CSM: LOT . < SUBDIVI •N 1 BLOCK/LOT <br /> (pu ' , ivate) <br /> PROPOSED PROJECT INFORMATION : `AFF REVIEW <br /> PROJECT DESCRIPTION: � II <br /> 3DI 3 U Ac, rIcC gid . I. onin "strict <br /> This project is a new building or structure. rmi Use?4 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB Ural ; <br /> i..____ EWER �S�RTIC (n- , xIStITIa <br /> c HEIGHT IN FEET: ' ,� NUMBER OF STORIES: (Not including basement) <br /> ® e - oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Sh' (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) I� ' . <br /> BASEMENT: 1ST FLOOR: <br /> fltr ,perl'nit <br /> 0 4, TOTAL SQUARE FOOTAGE: j ( p s+" i 1St # , <br /> • ...._S5 <br /> 2ND FLOOR: 3RD FLOOR: a x) <br /> WO <br /> CJV <br /> ❑ 'e' =wL• - +p1 ",• a .: <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ ♦ -1 (p 4 and a - -10 leo options <br /> (Please round to nearest dollar) $ / r{ J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Ye No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lNo ❑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? ❑Yes Ei.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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) J (Continue on Back) - ♦ --► <br /> I <br />