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ZONING PERMIT APPLICATION www.countyo1dano.conl SUPPLEMENT to Web•App># <br /> JPROPERTY OWNEWINFORMATION_1 . M; - cgr .i- CU TONER TO PROVIDE <br /> OWNER NAME I <br /> i��►CQcS IA.SA 6-X Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - t <br /> Dged Restriction; CSM <br /> 678 ,1ooK (;11.* ei reh <br /> 0?nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _ <br /> 5-3-6 - t y a i e Plan drawn to scale <br /> AGENTIINFORMATION rte- ?. ' t cCONTI ACT,ORRINFOR(IMgTIOtikt- g ny z' ` a `d includes dimensions <br /> � _ _ �f� <br /> AGENT NAME CONTRACTOR NAME rr <br /> NKi rt S 4 (,Joibt -?s.0de,,, it Plan including location <br /> AGENT ADDRESS CO_NTRACTORAODRESS �1 Orwell/Septic - <br /> �,24 e�hwlarcj4/ /`}✓� <br /> (City,State,Zip) (City,State,Zip) ` /Setbacks <br /> 514 1 Pr-mirie� (....).1 ,�S`l0 ❑S' e Plan royal from <br /> PHONE P NE <br /> �(,ro2b 6'37- 6,3/2 -•plic etownship. <br /> E-MAIL ADDRESS E-MAILADDRESS - . $ 4- co Ai. <br /> q Z;n,. e- , ti - H$. a..,o( • Floor plans to scale <br /> PROPERTY/LOCATION INFORMAL ki- (http.Uaeeessdanco,danevrn.us/) _µ ❑Elevation of property <br /> PARENT PAR ELNUMBE C RRENTZONING: ACREAGE: <br /> PARCEL (� �j frontage drawn to scale. <br /> NUMBER v �� ��l�� 7002 (0 � l <br /> TOWNSHIP: - SEC O��N:,, n� '/ <br /> 0C jr;s+ X9'/4: �ltl '/4'/:SLR ❑Driveway its <br /> e`^'"``fQ (stat ounty, town) <br /> ADDRESS: ( (J I � � e <br /> aon arc ❑Sanitary p: mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public •.rivate) � . <br /> 5.. 41- ;- Ili �i.' r' <br /> PROPOSED PROJECT-INFORMATION '- sir%i� KIEV IWWW <br /> PROJE T DESCRIPTION: p--� xa�, `�6 t .F t, <br /> Walt &ivory adds 4-to". ctLi oVe ?a rei p 41 61. Di '' , -: <br /> vim - � , <br /> This project is a new building or_structure. i=..--- a .- ' <br /> ❑ P 1 9 : Ifted * <br /> s project is an addition/alteration to an existing building or scture. y+ ' �-� 3 <br /> SANITARY SERVICE: ,}� PERMIT NUMBER: ` -5 -' <br /> . EWER . IX EPTIC "A fi - -_ <br /> HEIGHT IN FEET NUMBER OF ST.-IES: (Not including basement) o m - <br /> AREA TO NEAREST SQUARE FOOT <br /> ' '' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ '� - ,,=, <br /> BASEMENT 1ST FLOOR: A e$ r- <br /> 4, TOTAL SQUARE FOOTAGE: j ,4 e <br /> 2ND FLOOR:6)Qo 3RD FLOOR: l O 1 ,t . <br /> 77 �.� <br /> ESTIMATED CONSTRUCTION COST: E �` `� <br /> (Please round to nearest dollar) -■ r ♦ ♦ .+ /��� ) -- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des > • ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes t ''o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes • o -. _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es .. ri :o - <br /> _ 9P P PnY � P Y � . .. <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave b ank if none) <br /> 6. Is a location survey required? (see reverse) Ekes SNo: ['Don't know <br /> 7. Is this to correct.a violation? ❑Yes . <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) •—► —► —► <br /> 545-112{4/08) <br />