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ZONING PERIV1T APPLICATION vwwuoountyccrane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 7-iT �1g S c 14 LE ?3 Wing Status; CUP; <br /> • OWNER ADDRESS (Number,Street,City,State,4ip) <br /> Deed Restriction; CSM <br /> 0 4 2. .cA-e--1-4., I --4 (c Cr , (4)1 3S$3 variance(# ) <br /> HOME PHONE CELL PHONE IE-MAIL ADDRESS <br /> o o - 3l0' /� 17ZI'5Gh table s-,c^l'i. co......, <br /> Eerie—Flan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 7).1a4 CON]$ACTOR NAME <br /> �`E <br /> 1(b6^ J te'''c Ca . e Plan including location <br /> A NT ADDRESS CONTRACTOR ADDRE of well/septic <br /> / e ituit (¢ /27 <br /> (City,State,Zip (City,State,Zip) acks <br /> eyl4- b- (Als' z P PHONE Plan approval from <br /> � , s--7r _� r s applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -GA/ia-(r 6u 00(5 e'4(,5e1^el- RI F •orfl.- to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.Aane.wi.us/) `r lev. ,• property <br /> 0 PARCEL PARENT PARCEL NUMBER: /� CURRENT ZZON NG:� ACREAGE: <br /> NUMBER 056-7/34q tl -TOO C?f (Q��4 Q p(.A •stage • .wn to scale. <br /> TOWN;�jHIP: SE/yN: ' ❑ ive •-rn11tS <br /> 4UDRESS 7 S - co,nty,town) <br /> °04o L �k C Sa^��C-L r ! ( �( 5"3So3 <br /> CSM: LOT I SUBDIVISION BLOCK/LOT ❑Sanit. •-rmits <br /> I S—C c' (publi • ivate) <br /> PROPOSED PROJECT INFORMATION AFF - EVIEW <br /> PROJECT DESCRIPTION: <br /> 20i( 40' n o g District <br /> . <br /> MI project is a new building or structure. ermitted Use? <br /> fThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: (PERMIT NUMBER: Rural Add <br /> EWER VIEPTIC (new/-xlsting) \ <br /> HEIGHT IN FEET: NUMBED.OF STORIES: of including basement) <br /> Wetl. . •him•dplain/ <br /> S , nd (attachment) <br /> AREA TO NEAREST SQUARE F T: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FIR: Eros o a• of permit <br /> j TOTAL SQUARE FOOTAGE: l (slope • sturbance, <br /> filli : acce- ) <br /> 2ND FLOOR: 3RD FLOOR: �} <br /> 2} <br /> Review cati Survey <br /> ESTlll7 ED CONSTRUCTION COST: 20 Out, / and avails Options, <br /> (Please round to nearest dollar) bat, <br /> .\#/i) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es Sao Boni kn w <br /> 2. Is there a wetland or floodplain on or near the property? esVo on't know <br /> 3. Have you talked with the township about your project and are they in agreement? es L J(`Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es Jlo <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) Dies o DIDon't know <br /> 7. Is this to correct a violation? Dies o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ —► -4 <br /> sys_117 mesa <br />