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ZONING PERMIT APPLICATION www.countyoidanecom SUPPLEMENT to Web-App tt <br /> PROPERTY OWNER INFORMATION CUSTOMER TOPROIVIDE <br /> OR NAME -- <br /> --! �.&0.e +t e. TSo n e 5 Q zoning Status;CUP; <br /> OWNER AODREs°(Numbs.Sad Citf.Ms*aP) Deed Restriction:CSM <br /> -Z as m oar t(L0.41. Its mail s So» wz 5 3 7 / 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 5- lies'? , tri ones a.x 4 rn a,i(-C e r) Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> r 7 CONTRACTOR NAME <br /> AGENT' f � ben 4onaf r�ee.f;oQ Site Plan including location <br /> �/ of well/septic <br /> yl1rC N led G <br /> (City, <br /> at am (C+Ir.ago,aP°�••`'7 0 Setbacks <br /> C avou.r W r slit r" <br /> PHONE PHONE ❑Site Plan approval from <br /> gat)- 4160 - 3 3 k'9 applicable township. <br /> E-MAIL E-MAIL ADDRESS <br /> „�._. 0 Floor plans to scale <br /> PROPERTY LOCATP)N INF,)fiMAI ltiti it', 3 s -.w 0 8evation ofpfOpefty <br /> Q G7Oi-344-alai-( " 3 Pt' . 33 frontage drawn to scale. <br /> TOwNIMP. sEC IOtt <br /> rrld1.-4,s o n 707 rv�o4E, 310 Y4: Al '" P.Y.: 5 I- Q Driveway permits <br /> ADDRESS: (state,county,town) <br /> ?2 - movr lark,4 gd <br /> CSM: LOT SUBDMSION eLOCK&OT Q Sanitary pemlits <br /> PROPOSED PROJECT INFORMATION H <br /> PROJECT DESCRIPTION: Q:ratike...11-h/ 1, .�i'nr ly!1} • r ZOtiiflg District ' "1• ['This project is a new building or strucbxe. o�r5t / - Usie?`P1c'xTtas project is an addlbon/aiteradon to an existing bulding or structure. 1� <br /> SANITARY SERVICE- -PERMIT NUMBER: 0 R ,- a,Z.'IO <br /> IC . <br /> HEIGHT IN FEET. NUMBER OF STORIES (Nor including b_um t) <br /> AREA TO NEAREST SQUARE FOOT: : <br /> ( ) <br /> (Outside dm snsions Including unfinished erne.attadhed garages and above grade decks or porches) + r ,r ) '1 <br /> BASEMENT 18TFLOOIR +1OIM1.at11MIMPOMO + s ltr. I .. <br /> 1 <br /> 2ND FLOOR 3RD FLOOR: ;, F + <br /> OWtonc 3I� 51i f a <br /> ESTIMATED CONSTRUCTION COST: �1 -"-• <br /> (Please round to nearest dollar) -► -i -► -0 '. -. 'tR42 60„�V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 504o QDon't know <br /> 2. Is there a wetland or Aoodplain on or near the property? QYes jc . [)on't know <br /> 3. Have you talked with the township about your project and are they in agreement? likes • • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? an ,910 <br /> 5. Is this project associated with a rezone/CUP/variance(peltionlappeal I ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) QYes 2 • 0Don't know <br /> 7. Is this to correct a Notation? ass p' <br /> L APPLICATION MUST SE SIGNED <br /> 645-112 Loa (Continue on Beek) -► <br />