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ZONING PERIVIT w <br /> APPIJCATION wukooutycfdane.com !L1 u u a SI a: f�•�:ca•rc :! <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> N 174 cf 6 1 IL. <br /> NERADDRESS (Number,Street,City,State,Zip) oning Status; CUP; <br /> W <br /> 392,c W ercT MI wAl Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> GUS 512. ` fiq cr• E M _ G TOS• Nip lI I e an drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A;90C-IMC0 t NAcd-j'rS ,sSZC'?t1170 NeKSEIUXItcc(+Ts 1:�}Site-PlIn including location <br /> AGENT NDRESS CONTRACTOR ADDRESS of well/septic <br /> 15riar, ion IZ( 041-14467) ST. <br /> (City,State,Zip) (City,State,Zip) backs <br /> 1M4OI So • !NS 53 f(? <br /> PHONE PHONE ❑Slte, proval from <br /> Got - 3 4(S-• 5€j ap " township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> (v.IAra C N0K9iWbet(4ti.5. (OWI 13,1,R6cirplans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P rty <br /> 0 PARCEL NUMBER 07-00 — O 6'a --0-/Q%-a-1 �7 S3 .9 U y frontage drawn to scale. <br /> /fOWNSHIP: SECTION: <br /> VIM I d Ot e MA/ 70VA096 O4 '/4: N G '/4'/4: /J� El Drive ermits <br /> ADDRESS: ( Unty,town) <br /> 4811 uv CST W va ❑Sani -r •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> eT•c ,map vorcusY (publi _rvate) <br /> L. t," 3 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A Pits g p -faro( ong District <br /> . EIThis project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> DEVVER nEPTIC p/A (new/ ► <br /> HEIGHT IN FEET / '_NUMBER OF STORIES: (Not including basement) <br /> '_ 6'' QJ _ �,S 1 Wetlan• to••plain/ <br /> -AREA TO NEAREST SQUARE FOOT: Shorela attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Erosio Ontr permit <br /> BASEMENT: 1ST FLOOR: <br /> ,- �6o 4, TOTAL SQUARE FOOTAGE: j (slopes, ' urbance, <br /> fillip / <br /> 2ND FLOOR: 3RD FLOOR: <br /> s -Z-60 2vIew on Survey <br /> ESTIMATED CONSTRUCTION COST: and avai options. i' <br /> (Please round to nearest dollar) ♦ • ■ • ♦ ♦ ♦ $ SO d 00 <br /> L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des lac DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Des o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Wes LVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a. <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) Dyes 0 o ODon't know <br /> 7. Is this to correct a violation? Yes 2 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> c4c 117 ldRfRl <br />