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q' 1115D <br /> ZONING PERMIT APPLICATION www.I o d SUPPLEMENT to Web-App # <br /> ty ne com <br /> PROPERTY OWNER INFORMATION <br /> cusroMe TO PROVIDE <br /> OWNER NAME 1 ,l(�� .i p�y. <br /> cv 4 - etc o v �v c�tpr [zot ng Sta s;;COP, 1 t3 <br /> OWNER ADDRESS(Number,Street,City. ) l Deed Restriction;CSM <br /> aato3 V,avHVv■cly; R) . vvgQy.-e* . t wT Variance(# ) <br /> HOME PHONE CELL PHONE F-MAIL ADDRESS <br /> S^ 3 1\iceeissNtmew1 o Ahw.t•x 0 Site Plan d <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indudM <br /> NAME <br /> Jt� •LAP P J\p &-)A)tv4i. 0 Site Pla ind ng location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of welUse <br /> (City,Slate,zip) _ (City,State,Zip) 1:3 Setbacks <br /> t.6...sStrMt.t l�X S35% <br /> PHONE PHONE El Site Plan a•• • 4, us <br /> 772' 7 S\ —1132._ applicable tk7 i•. <br /> E-MAILADDRESS E LADDRESS <br /> --'...•••�� v"C e se'i a-1Ma.t , 0 Floor plans to cale <br /> PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wl.us/) 0 Elevati Of party <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ARREA <br /> [PARCEL <br /> NUMBER dsIt• 233',ink-O frontage t0 scale. <br /> TO n \ .tf 4: S e. %/.: SW E---;ri rmits <br /> ADDRESS: <br /> ept64tate, nty,town) ) <br /> N bT RSS t�h4T ? t?- l&O Gvi t ki e CSM: LOT SUBDIVISION BLl KA OT 1 �- <br /> cam• 1`i�5e'{ (public,pie,' <br /> +ry e, 3 bd. �N1 <br /> PROPOSED PROJECT INFORMATION STAFF( <br /> PROJECT RIPTION: 1 ` l <br /> NI e...s t vesw�e- Cev�,b-4-vac, t O+/∎• ❑ Zoning DI Ct <br /> This project is a new building or structure. ❑ Permittl SJ�e� <br /> This project is an addition/alteration to an existing building or structure. V <br /> SANITARY SERVICE: PERMIT NUMBER: l r -I ❑ �R�uaraal Address <br /> EWER NPTIC Se.4 l - ThOs, `V _ .; M roN//existing) <br /> HEIGHT IN FEET: /► 14 NUMBER OF STORIES: (Not including basement) �'�7 �/ <br /> +�-t`Jpin ❑ Wetland/Floodplain/ <br /> ", Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached ga s and rove grade decks or porches) <br /> BASEA�E i_w` / 1ST FL q...77 ❑ Erosion •ntro rmit <br /> Ib 150 v + TOTAL SQUARE FOOT (slopes, . st '•=nce, <br /> _NO.cl.o_R: �w sRCITE : Pe ll filling/a•,•=-s)Lilvta <br /> r Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ .4. ♦ $ ^ and available options. <br /> (Please round to nearest dollar) .p p(50.600 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ,81lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes • 0Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ORS • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Rtsio <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) Ekes inflo ['Don't know <br /> 7. Is this to correct a violation? [Ye <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -► -0 <br />