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<br /> ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> VN\-'l'`'ccX "5\`„^'X ❑Zoning Stat ; P;
<br /> OWNER ADDRESS (Number,Street,City,State,zip) Deed Restri . n; CSM C c 0.0\, GG Qv e. L1 S3Z� Variance(#
<br /> )
<br /> HOME PHONE E L PHONE ADDRESS,
<br /> C.,bg —212--001A R(\\NI\\\> ?$ a
<br /> G vv:'\•co,,, ❑Site Pla awn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION : and incl es dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> o41,- . 9-oG\,,^,,,.� ❑Site Pla Vi uding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic
<br /> \111 t,Jes{' r‘a:n Sf
<br /> (City,State,Zip) (City,State,Zip) ❑Setb s
<br /> cx„,,,,1.,r;c) a V►L SC23
<br /> PHONE PHONE ❑Site Pla -p. rom
<br /> c,r74S V6 7 Z« applica•f- • sip.
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> � G,R.,oc.\,,,,fl.,Q gM G ., Co r■ ❑Floor pla s scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane co.danewi.usn ❑Elevation of operty
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> PARCEL rr u (� frontage n to scale.
<br /> NUMBER �bjj f - IC700 -O g
<br /> TOWNSHIP: SECTION:
<br /> �4: %1A4: ❑Drivew.y :-dip s
<br /> ADDRESS: (state, 0 nj,, ..wn)
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑(public, ItS
<br /> (public, r� e)
<br /> PROPOSED PROJECT INFORMATION _STAFF:REVIEW
<br /> PROJECT DESCRIPTION:
<br /> D ct
<br /> ❑ Zoning Ga�o.oC,
<br /> This project is a new building or structure. ❑ Permitte�'Use? ` -
<br /> ['This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rufal AddreSS
<br /> EWER PEPTIC (newie ti g)
<br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement)
<br /> \Ca c kl' , \(2\m,. , ❑ We tland/FI d I Shoreland a F nt)
<br /> EA TO NEAREST SQUARE FOOT
<br /> (Outside dimensions including nfinished area,attached garages and above grade decks or porches) _
<br /> ❑ Erosion .ntr , It
<br /> BASEMENT: 1ST FLOOR: ("'•
<br /> a0 � (fi 4, TOTAL SQUARE FOOTAGE: 4, (SIOpeS, I- ■t nC ,
<br /> T filltng-7acA� ss t
<br /> 2ND FLOOR: 3RD FLOO
<br /> ( ZED Scti-Ft. ❑ RevlewLo� '4.:-,-
<br /> • ...,: r.-,,,
<br /> �'
<br /> ESTIMATED CONSTRUCTION COST: t 000 and avails+� o•
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ❑No ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Yes al 1 o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes �I o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? laes '❑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? Efres ]No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -i
<br /> 545-112(4/08)
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