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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION-7-- <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> D A-V i I) G tecK 141A-10 �^141A-10 ew l' /r�l(}-51— Wing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) c UM Pa-0 /e l� <br /> _JC/ eed Restriction; CSM <br /> Xe:t 3 I get) rr (....A-iU 4 PKuO41 5 3�Q b Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> NJ • <br /> ( .09. 8'37—' 8 '(auN4Li Fe.1,2 # C10141i-iv IePlandrawntoscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS CONTRACTOR ESS of well/septic <br /> (City,State.Zip) (City.State.Zip) backs <br /> PHONE PHONE ❑Site PI a al from <br /> applic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> lour plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARENT PARCEL NUMBER: CURRENT ZONI G: ACREAGE: Ele of property <br /> ❑NUM ER CFR 3oti1 CO Zr $ P —( I. ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> n <br /> L f+.'q I 1/4: '/a'/4: ❑D riv a rm its <br /> ADDRESS: /,, t,��,� (st , ounty,town) <br /> ." 1-- I SC 0/H "- J Pkv)\ ❑Sani ry rmits N <br /> CS LOT S DIVISION I BLOCK LOT <br /> (publ' rivate) <br /> ve- <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> pLi4ee A-Lim-A-vet '8 oILr 5t4EJ bAJ Berr_, oc Lerr ) Distrtct <br /> . ❑This project is a new building or structure. <br /> ermined Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ /Rural Addr S <br /> EWER 'EPTIC (new/ <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) <br /> I e lain/ <br /> Sh' n (attachment) <br /> AREA TO NEAREST SQUARE FOOT: Orel <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,�� / <br /> �L'ErosionControl permit <br /> BASEMENT: 1ST FLOOR:/G O 1 <br /> 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance/t <br /> ci <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> IGO ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► ♦ Q� and available o , ns. <br /> (Please round to nearest dollar) $ re <br /> IVO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑YesJNo ❑Don t know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes cgiVlo ['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? Dies 'lo <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 -- to ['Don't know <br /> 7. Is this to correct a violation? Elves Io <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -+ <br />