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Dg `oi rru8nq 3L 9 0 E. '17J,4i,IA:11177/717:1711. <br /> ZONING PERMIT APPLICATION wwcout odne.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME gvs.y le sse. i I, , (t/ zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) C Deed Restriction; CSM <br /> g 3 41 o PviN ickp Pen t 2a tA4zorrAn i& J5( O Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ZSite <br /> 0635.137 ; G,' 0 612, 3 ChoAI NaAly tm«4@�9''"�,,I ' ePlan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ‘I `�--oW N-r I--IbPAC 0v/1\1iSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) • (City,State,Zip) S tb <br /> PHONE PHONE lall Site Plan a..,o rom <br /> a plica.;• .1 ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor Vto scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) Elevate n roperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCELD 0101,.13 �14 16d 500 R�,Z 3 frontag raven to scale. <br /> NUMBER 1 <br /> TOWNSHIP: SECTION: SB( Drive er is <br /> Iow+‘ o F- 2oX6orY 5�.i 1/4: 5 6 1/: 3 1 stat town <br /> ADDRESS: G ( �1"`" ) <br /> i 310 ,::;DUrdete Kollo..✓ E0i MAic7w�.r � �✓1 535'0 �Sanitarypermits <br /> CSM: 11 Z 0c7 LOT SUBDIVISION BLOCK LOT (public,p - ) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECTN((9 .Vey 5+ora e_ 4 aes yr../ bir lot ((Ye_hArv) L❑ zoning 134tri <br /> ®This project is a new building or structure. ❑ Permit +e 1 se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U Rural Address <br /> • I bEWEREPTIC (new/e)► <br /> HEIGHT IN FEET: % 1% 1 NUMBER OF STORIES: (Not including basement) <br /> 1—: II 1 1 A OQer r \ ❑ Wetla�� loo plain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOrAl t attachment) 4" <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR ErosionControl permit '' (�O� <br /> 2S 2 0 j, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, I "`/ <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ,, n tj ?j <br /> 95 '� Revie L atio urvey ,• <br /> , 1{ "'t <br /> ESTIMATED CONSTRUCTION COST: 0 Z•�o and a options. <br /> (Please round to nearest dollar) -4. -i. ♦ Fe $307-3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?........... ElYes 4,' No . DDon't know (��r. <br /> 2. Is there a wetland or floodplain on or near the property? EC Yes f No. QDon't know ; IcX <br /> 3. Have you talked with the township about your project and are they in agreement? ©Yes QNo \ ' k4A k <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?... EYe# (leaveblankgNoif t �` <br /> 5. Is thisproject associated with a rezone/CUP/variance (petition/appeal ) none) "�` <br /> \ntG, <br /> 6. is a location survey required? (see reverse) 7Yes 131NoDon't know.. L7 <br /> 7. Is this to correct a violation? Eyes ®No (U� <br /> APPLICATION MUST BE SIGNED <br /> (� I�{'- //_ (Continue on Back) —► —► —► <br /> REV(01/19) o 4-t_ (A) t p pee- f L' „1 lo l 7) Y✓757 <br />