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ZONING PERMIT APPLICATION www.count;75403.6"'�:G _SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER 22,1E <br /> 04•V 1�/. 41rLS4,41 ❑Zoning St us r,--rot,OWNER ADDRESS (Number,Street,City,State,Zip) Deed R OS <br /> �3 9 9 'e-re✓1 /e • /10-7 Varianc ( <br /> HOME PHONE CELL PHO E E-MAIL ADDRESS <br /> 6:'De Fer4 527- ' 147 ;.:2-s-441 . ,4S .4-9t j gmite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location Iv- <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) atetbacks V <br /> PHONE PHONE ❑Site Plan�p�r om <br /> applicab e� sh' <br /> E-MAIL ADDRESS E-MAIL ADDRESS V <br /> l <br /> rloor plans to scale V <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER OZz.0 y08'/3/_kavy ft/6£x) 780 frontage drawn to scale. <br /> TOWNSHIP: /q/ SECT 1 A114- `� /3- /it%: /✓,E 1/41/4: ❑Drive i <br /> (state ) <br /> ADDRESS: 71.. <br /> G3 f q Ivhi✓ ;' <br /> 7 , 2 D >24 1=1 1.� Sanitary permits {,,,� <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) ND IIW <br /> PROPOSED PROJECT INFORMATION J <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1,4l/eL , 471-741Za A ,L'-Z, , '--. ❑ Zoning Diktat- <br /> . FThis project is a new building or structure. ❑ Permitteise? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER EPTIC (?C$"-ZQ‘--- (new/ig) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Z. ❑ Wetlan. ,,•dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shovel %�' achment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erorol permit <br /> // '. j TOTAL SQUARE FOOTAGE: IF rbance, <br /> 2ND FLOOR: , ^ 3RD FLOOR: ((�� �( flllln /a ess) <br /> �� ! '� ` ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ ♦ ♦ $ may; ®/' and available options. <br /> Please round to nearest dollar) p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes EINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? glYes 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 ®No ❑Don't know <br /> 7. Is this to correct a violation? Elves gNo <br /> T <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />