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✓ suppLeotwoovictApp# <br /> ZONING PERMIT APPLICATION www.courityoftiane.coln <br /> PRGPERTV:OWNER INFORMATtQN CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V e 0---1 t.1 .ri r .0, , c- LL. c_ 0 zoning Status;CUP; <br /> OWNER •'•-- (Number,-eat, _ Deed Restriction;CSM <br /> '�a i I . #\A���I. L1 P.( .1 !t. i' t : - --, kit ` -11' variance t#._.._.._._.._—) <br /> HM tut CELL PHONE E-MAIL ADDRESS <br /> LF f .} Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONrrti.CTCR NAME <br /> 116 A. 166; !/r' ❑Site Plan Including location . <br /> AGENT DORESS CONTRACTOR ADDRESS ofweWVseptic <br /> (Ct(c stza ZIP) (04 8116.rIn) G Setbacks <br /> PfiONE PHONE <br /> 0 Site Plan approval front <br /> - , applicable township: <br /> C-RAAit.ADDRESS EdMItADDRESS <br /> 0 roar plans to scale <br /> PRDPERTYWLCCATION INFORMATION .(hllp:'�accessdane.>:adane.4vi.usi) Elevation ot property <br /> . <br /> RABBIT PARCEL.NUMBER: �ZONING: ACRD frontage drawn to SCE. <br /> .Ll�h. Ir - <br /> TOWNSHIP: SECTIat+t a•tiv YOeralfti <br /> -'177-1 = (state,county,town)ID CORE r' , <br /> 3 v; Si 1i V' r - £oa ' Q Sanitary permits <br /> OSM: ' SuBDMSION SLOCK)LOT date <br /> lY.,�,'u�r p. <br /> PROPOSE° P&OJECT INFORMATION ti <br /> nn <br /> PRO.IecraEechlarlaN �' f, r. _` ud c,:_o it���"r''tilL+ p-� I <br /> • . his project Is a new building of structure. . <br /> r.:1 This project is an addition/alteration to an existing building or shuctura <br /> Ef{VI <br /> I SEWER Cj SEPTIC — coC/l r • . I ' <br /> MIGHT IN FEET j aFSTOR Indirding b�sa" ' . <br /> 30 <br /> AREA TO t4EAREST SQUARE FOOT' <br /> (Outside dimeneions including unfinished area,attached garages and above grade decks or pcaclias), <br /> a r /7 5— = 131. r rAt A rt ee <br /> o / i IP . 3RD FLOOR: - <br /> 2 - 3 ( t <br /> ESTIMATED CONSTRUCTION COST $ $• Z le <br /> (Please round tensor* -� ' - -► -► - .`.+F ( . - • <br /> 1. The property 1s within 300 feet of a stream or 1000 feet from a pond or lake?........... 0Yes <br /> L No ,O Don't know <br /> 2. Is there a wetland or fioodplain on or near the property? OYes (No O Don't know <br /> 3.,Have you talked with the township about your project and ere they In agreement?.... . Yes 0 No <br /> 4. Has there been a zoning permit issued far this property In the past S years? L f Yes 0 No <br /> S. to this project associated-with a rezone/CUP/variance(petiiticmiappeet#_ ) c4V0 blank if none) <br /> S. Is a location survey required? (see reverse).< .....,...<..................................._ <br /> •Yes O No C!Don't know <br /> 7. Is this to correct a violation? ..... Ca Yes 12(Na <br /> APPUCATION MUST BE SIGNED <br /> (Continue ois Back) -4. -►- )... <br /> 645.112 PROM} <br />