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ZONI PIERIVITAPPUCA11ON _ - l con SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO RROVID <br /> OWNE M / <br /> OWN M • ( umber, ,City, i,Zip) azOning Status;CUP; <br /> 0. ►. �' / / /l� Deed Restriction;CSM (/ <br /> h (� • 53.5"72 vai.. - • ) �DIj <br /> HOME PHO : PHONE E-MAIL ADDRESS <br /> i " " f 8 - i- 2 9&' I 3 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4 !` <br /> AGENT NAME CONTRACCT° NAME '/ <br /> (� I-/ y /30'449 [[Site Plan including location 4-� <br /> AGENT ADDR: - CONTRA CCCFORADE,brs/ C [ of��p� /��� <br /> (City,State,Zip) 0 4d4.' 5/1 ..,, � . a / <br /> (City, .Tip) 2 u.• <br /> PHONE PHONE <br /> (Ae 0n.9 (j 4{ Site Plana • <br /> from 4 <br /> - �7O Q • .. .. _ . nship. <br /> Alf4. 5' EC/ <br /> E-MAIL ADDRE. E-MAIL ADDRESS 7„, <br /> ►�� • - . to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN ZONIRO: ACREAGE: 14 Elevation of property <br /> El PARCEL o o7-d33 �i2-L /��/ /C/, frontage drawn to scale. F-• <br /> NUMBER !f /f 7[J <br /> TOWN P: SECN: <br /> S /i �, /���e '/4: w %%: �� Driveway perm; jedef- <br /> _c ` <br /> ADD Ess: (state,county, own <br /> 9 /V ;i9� w„ I iW/ /hat , 535-7 7`14- / <br /> CSM: � � ` � /hr el) 3 7 z 'Sanitary •�•.�its I <br /> LOT SUBDIVISION BLOCK/LOT <br /> (public, •�j ��° r� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT S.' . ON: �L �i � A —)/Y- 'Ian �D �x 1.6/,n7 /���1//l.`rr7- 54 / ]zoning District <br /> This pro -,t is a new building or structure. /� P�Use? A-d_0 t 1-0 <br /> ri This pro -. is an addition/alteration to an existing building or structure. a , <br /> SANITARY SER PERMIT NUMBER: 1'A RU! I ' .;.u: sI i <br /> / <br /> R A vi.EPTIC T <br /> HEIGHT IN FEE <br /> NUMBER OF STORIES: (Not including basement) . <br /> 'r di ,WetlandJFl•..•lain/ <br /> AREA TO NEAREST SQUARE FOOT <br /> Sh• : :, e# (attachment) <br /> (Outside dim: ons including unfinished area,attached garages and above grade decks or porches) t <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, 0 / <br /> 2ND FLOOR: 3RD FLOOR: fill).g aCCesS'm ke, /, <br /> a00 4 4 Review L• • <br /> ESTIMATED •• STRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ a _. <br /> (Please roan. t• nearest dollar) $ 02550a OU <br /> 1. The prope 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 e land or floodplain on or near the property? QYes ]lo []Don't know <br /> 3. Have you -1 ed with the township about your project and are they in agreement? likes laic, <br /> 4. Has there se-n a zoning permit issued for this property in the past 5 years? IYes lNo <br /> 5. Is this proj=c associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locati• .urvey required? (see reverse) ❑Yes 74 • QDon't know <br /> 7. Is this to C• -ct a violation? nYes r • <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -.• -10. -0. <br />