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ZOMNG PERK APPLICATION www.caudyekime.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION r �- 0 _. TO PROVIDE <br /> OWNER NAME <br /> Peg6q IVY '\) la4 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Sheet,City State.Zip) E- • Restriction;CSM <br /> 5(32 GS I<-,atf1 ( I��cGI , g(UG�fA.r'�hl WI lS (# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> Le°g9.US' +A) 1010.1.25'4942- ' --' - / / ■ "Melillo 1-64,"—a <br /> Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION includes dimensions <br /> AGENT I 16 c K arc of>�( ► - , Plan Maine location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ■ - )/septic <br /> S I3a- Cw r V s Krq all 5132 G.UFhi ViAJA1 WC- <br /> (City,Stale,zip) \� e• r <br /> 616-CItei YI-Li L„- S3i r 61AGk- Q,vt1/I ,1/44 5.3s(S <br /> PHONE • ' S Plan approval from <br /> k� �7 al Z- C,1 o 0 (,OQ' L17j-740 p•:•,;r_,• township. <br /> E-MAILADDRESS E-MAILADD <br /> x-4911,1 t Soo b lax-11:4' a H011 rri/l .. loor plans to scale <br /> PROPERTY LOCATION INFORMATION http: accessdane..cc.dane.wi.us <br /> PARENT PARCEL NUMBER: ING ACREAGE: _'°•' Of property <br /> Iv <br /> ❑ PARCEL 0% (n ..143�1ZO-0 K .: 4 • ,r r:- drawn to scale. <br /> NUMBER V t� 1 ' 1 <br /> TOWNSHIP: (� A /� �1 ioN: 1/4 section Oh of l4 <br /> MI `� V ta,�rn ai" `- %: ��Vii: C I--` ,� h _ pelTl iit.S <br /> TEss: <br /> ,c-\) (state,county,town) <br /> GOrtrvn-ac(d., A tz.oirani'-C, W( <br /> CSM: LOT SUBDMSION BLOCK/LOT a Sanitary�� <br /> 1 . 01-1 3 esM i2o 11 L,,i- •ubtc,per) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT o '1 <br /> / r�7Jt�� � � V O�� <br /> It V 3 <br /> • 'us 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: �^ i <br /> ❑SEWER IJi�SEPTIC 13- 015- - 00 15Z- <br /> HEIGHT <br /> ��� �C D IX SEPTIC NUMBER 0 f I�STORIES: (Not including basement) <br /> 'ZL/ 7`- <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) , , <br /> BASEMENT C ^ ©,rI 1ST FL ,S 6 9 <br /> j TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: 5' 7,_■ <br /> ESTIMATED CONSTRUCTION COST: _0. -, - — ♦ ♦ Sco('e) (IC) / ` ) <br /> (Please round to nearest dollar) v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes A No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑ <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 • -) <br /> 6. Is a location survey required? (see reverse) ❑Yes V ':• ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ■ No <br /> 1 APPLICATION MIST BE SIGNED <br /> I I1 (Continue on Back) ■ ■ -+ <br /> 545-112(4/08) <br />