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"._5 c9 o4/ <br /> ZONING APPU^-11ag www.00Ilf7 1a00n1 SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME.. <br /> -�'`!/We:- U'�V�! � ! '' `�U�/op �`J��, <br /> 01/Zoning Status;CUP; Y _ 1 <br /> OWNER aDDNumber,Styli,City,State,Zip) / Deed Restriction;CSM 'v 30 <br /> 7 ,�t"'`!cv(/'!/� , ? - Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6,05.- SSA ©k,,,b'asl7 Dore- ` ro' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions �0 <br /> AGENT NAME / CONTRACTOR NAME �- <br /> 7 77 4 1 44 4i f 's& '�kerG/ce`05 Site Plan including location > <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> KVk.�� �2& / ='a 1•y, o(� / Øo/(t)(City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE �- "�Site Plan approval from <br /> k6— --Y--SJ grC' .72,0 --76 6-'q3e. applicable township. C •I <br /> E-MAIL ADDRESS /l E-MAIL ADDRESS <br /> rt.-"G4,y b74-,c4 eft, ('®f'! !/R, `I g Sra,c r 7).-4.,43/7,, C',,,,-Floor plans to scale <br /> ._ PARENT Y/LOCPARCEL RMATION (ht CURRE cZON NGne.co.dACREAGE:SJ) �,i Elevation of property <br /> ❑PARCEL 0f(f.3 f� I. oD/,_G (3r I 26, 12 r frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECr// ^ <br /> t'` `` ! '/a: J6T 1/a'/4: WE Et Driveway permi <br /> ADDRESS: ti-111,_.-mr.r.,uuiW• <br /> � a -- G v' rd <br /> I 0 <br /> CSM: LOT SUBDIVISION BLOCK/LOT r♦ �M'=" permits <br /> (public, rivate) <br /> PROPOSED PROJECT INFORMATION Weria ii14J:T=i°+i r_ <br /> P CT D CRIPTION: /� L •l� G r S C P S P7 t Ci S lti,•L"� '' Q/!C' %ZorungDlstct <br /> f This project is a new building or ssfructure. 1 4CO©/r' 2-©PCit_^cS �- ,E gd d <br /> Et'fhis project is an addition • to an existing building or ure. <br /> ,�,r4/4.e 6:Oemtitted Use? "fd <br /> SANITARY SERVICE: PERMIT NUMBER: (� t*4/ R - "0,91°^ ' �L 1.e,' -s <br /> EWER �• �' "`�o% 'C l 9) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) _ �,/. ■ N <br /> 1 �;a : . i.° (attachment) 01--. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) .j ;Or1CORt[O(�f6frtNlt <br /> BASEMENT: 1ST FLOOR: n <br /> / V 7 '-7 /5 3 j TOTAL SQUARE FOOTAGE: slopes,distur rice, ��y /` <br /> 2ND FLOOR: l / 3RD FLOOR: 7 n a ss) / <br /> `�'� `� t Review ac ion Survey <br /> ESTIMATED CONSTRUCTION COST: 7� / and(Please round to nearest dollar) "♦ ♦ ♦ ♦ ♦ ♦ /i, available options <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes 9No <br /> No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes ❑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 fNo aDon't know <br /> 7. Is this to correct a violation? :Yes No <br /> D6 APPLICATION MUST BE SIGNED 4:::::7' <br /> 545-112(4/08) / <br /> (Continue on Back) -♦ <br />