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k`1,o 1(0 <br /> ZONING PERMIT APPLICATION www.countyofffe.com SUPPLEMENT to Web-App # <br /> an <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA/ <br /> ME <br /> �'yrl S ra.L4 h ❑ Zoning S -tus; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> (i 3 1- g«o� , V ( £3 s9 3 Deed R:. icti n; CSM <br /> cc,-•-• n !�' °`"`� � Varian.�� ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> to 00 ` at.169?s 4 t1 ' L w"°°• co ❑ Site Pla draw scale <br /> AGENT INFORMATION � CONTRACTOR INFORMATION and incl dimensions <br /> AGE T AME _/ CONTRACTOR NAME <br /> a ti to,..‘ tr7C (S ❑ Site Plan 'nclu • ocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se f <br /> 1( 2 /4 (¢NIZo7 <br /> (cif , fate,Zip i1� ^ ! 3 7....— (City,State,Zip) ❑ Set CICS <br /> w Jl� <br /> HONE PHONE ❑ Site Plan ; ••r al from <br /> 6e0 3- 5c--7Y-- l p applica•,6 <br /> E-MAI ADDRESS L E-MAIL ADDRESS <br /> 6440,. /i K '�ooCse�/_, ❑ Floor pla is to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) ❑ Elevation f r erty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 1:1 NUMBER 6--709_213 3— los -o A_ — 0, 8 frontage w scale. <br /> TOWNSHIP: (,#,.., SECTION: <br /> is '/a: '/4'/a: ❑ Drivewail s <br /> ADDRESS: (state,county, own) <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanita its <br /> (publi I <br /> PROPOSED PROJECT INFORMATION -'a STAFF e! <br /> PROJECT DESCRIPTION: <br /> ��0 - .20'Y 9p r e- 5 1. _ <br /> . ❑This project is a new building or structure. �' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1 Address <br /> SEWER I I newly ,�;s r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,� <br /> band .•.per <br /> r <br /> AREA TO NEAREST SQUARE FOOT: / �� %"= f <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> {', <br /> 1 ;.,,;% • <br /> BASEMENT 1ST FLOOR: Q O 7 ';';1-V;,1 � ? <br /> ;lee'j TOTAL SQUARE FOOTAGE: ' , , , <br /> ' �n� ) <br /> 2ND FLOOR: 3RD FLOOR: gv° „�k ss, , <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ � K .,Y n1 <br /> (Please round to nearest dollar) IKJ �` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes g No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 5/Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ❑No <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) ❑Yes E No ❑Don't know <br /> 7. Is this to correct a violation? El Yes EINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />