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SUPPLEMENT to Web-App# <br /> Z� sING PEI lITAPPL MITONvwv wcoa tyi Com SUPPLEMENT <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME j!e,/e n /Sh <br /> a r/e alit El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City State,Zip) '',n, /�� Deed Restriction; CSM <br /> 7 N If .;<<✓� rte/ 1,1 e roV 4 1 &-)2 �j� - Variance(# ) <br /> HOME PHONE CELL PHONE E--fJIAILADpRESS <br /> /, kris-(/70 6 1..Z-$-6/70 al�.rsee-l.ar�.s. ►4t-f� <br /> 0= Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME Vol SiLcaa. Al,.y.- e•� L c 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> g-/ 7 /0 - C ei ' ` <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE Q Site Plan approval from <br /> 6.8/ YS----6/7o applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDI7ESS LAS" NG <br /> f <br /> Li�kr-s® 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn QElevattOn of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> QPARCEL 0Cy_0607-Oat-VIP? 4-/ 5---g-7 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: S SECTION: <br /> P�--,ti,-�u-l€ . . -1/4: NE V4'/4: o0( ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> / 7 i)- ,7i al, vim.. ) t,)1*-- S3 ss3 QSanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> p (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 'd- ,n i c,4-- A p 64.•∎or 3- SrAtc,..., a Of <br /> a bow+e R "? u x 9c.-a.4 ❑ Zoning District <br /> his project is a new building or structure. / _Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER JEPTIC Sy4,N- /Z 6•5"- (new/existing) <br /> HEIGHT IN FEET: % NUMBER OF STORIES: (Not including basement) <br /> 9.-11 Z (c. 44, ,S. 0, c,.•s ; ) ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCOntrol permit <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /0 £g0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: �, D and available options. <br /> (Please round to nearest dollar) <br /> o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes ao Epon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o RIDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 'lo <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 to ['Don't know <br /> 7. Is this to correct a violation? DYes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />