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May. 7. 2015 8:21AM No. 0304 P. 1/8 <br /> ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> .Si f'era�i Y\ _A)a r <br /> wt, f ot vt r-e4A--vt't,5 LL C- El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Srar Zip) <br /> '' I Deed Restriction;CSM <br /> 1 593 N,S • %q/ k ' 12-1- if? Variance(# ) <br /> HOME PHONE CELL PHON -MAIL ADDRESS <br /> 66•' 9 `+- - lJ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT OR NAME <br /> �a.Va.- N.a.ns o v` R.+-t e.— e_ov15i-. 1.-/..e.— ❑ Site Plan Including location <br /> AGENT ADDRESS CONTRACTOR ADDRES � n of well/septic <br /> X73��1 .Uervsp.vv �3 Qy jje r nova .4 <br /> (Cu hp Zip) U '6-35T 59 (City, .1.-,Zip) �� 0 Setbacks <br /> PHONE �J PHONE _ 1 ❑ Site Plan approval from <br /> 4.0q - n1.2...- ,'S—(�O z _ cp O 'g - !Z'- 5-6 o Z applicable township. <br /> E AILADDRESS E-MAILADDR fss <br /> e IA.t W,e, L 40- • (e ."-4J Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http;!/accessdane.co.danc.wi.us)) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> 0 URMBER _Otf DI 35 1-y�)D-D ,4 - 1 t A -x-41-2- l5. 13 Montage drawn to scale. <br /> N <br /> TOWNSHIP: SECTION: <br /> /o ` / I"a Ve ,A: 'NA: ❑ Driveway permits <br /> b (state,county,town) <br /> ADDRESS: �� Q <br /> /8 f.3 v`, _ 'r 10R'4- ) o - ❑ Sanitary permits <br /> CSM: LOT' SU DIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION `- _. - --'7,7,1�. ._ <br /> PROJECT DESCRIPTION: /� = -— <br /> De \-1%1-\(\,-e Z 6-a,r- _`,,,M.,o,. I ti: G�i <br /> This project is a new building or structure. _0t.;(1 H« ,','4,-,--::.;: —= <br /> ❑This project is an addition/alteration to an existing building or structure. = <br /> SANITARY SERVICE: PERMIT NUMBER: _g s- �-..,�'4.,I"F.,.; --. Y <br /> _;= '1 ;;1 rtF. <br /> ❑SEWER SEPTIC •Yz '' <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not Including basement) <br /> AREA TO NEAREST SQUARE FOOT: F: ter r 4 t,rN., i�aQt .. <br /> (Oulside dimensions including unfinished area attached garages and above grade decks or.porches) , _ __,-4,-- <br /> ` <br /> BASEMENT 1ST FLOOR: inf l a 1' >i 7 I. <br /> ' S 00 l' TOTAL$OUAREFOOTAGE: 4 4-7•11�r 1i iltI ; �r r r <br /> 1 `l11 1 ,; t: .::i i <br /> 2ND FLOOR: 3RD FLOOR: / _- <br /> ESTIMATED CONSTRUCTION COST: ^ :_ -s.t}t ; i 1--5 11,f j. <br /> (Please round to nearest dollar) ♦ '~ ♦ ♦ '� ' ,t00) _ --_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes /2 No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? f l Yes [No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes SI No <br /> 4. Has there been a zoning permit issued for this property in.the past 5 years? Lilies jNo <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) f lYes ►/No ❑Don't know <br /> 7. Is this to correct a violation? . ❑Yes El.No <br /> APPLICATION MUST BE SIGNED <br /> 645112(a ) (Continue on Back) -0, -0. -0. <br />