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_C7E -F,i-cycic._,- Ok.otte (-5 ve el- - <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLI TION www.cohntyofcne.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> bA>-IC- Co L.,,..kT`f C rog"L 1/4"J nC-sle-S> n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Z,lo MAIL-I- 1-.v"T41FR- 14trJ14,. &'"b gm IN Variance(# ) <br /> HOME PHONE ,CELL PHONE E-MAIL ADDRESS <br /> 11)04) 7-4o-1 0 11 .I E$E. OFDAnic.Conn FBI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME T FAb6e? -Aq--aF 144-abS �ETraz� 5v 1 , S 1at S v <br /> t-Slfo4s ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> k7_0o E. gF,2cNIA ME kb I-0c•-1ST t:›12.3.16._ <br /> (City,State,Zip) (City,State,Zip) ® Setbacks jot <br /> q 6 4-0/4 A w1 '3593 'JE -o- !k- wi S3513 <br /> PHONE PHONE El Site Plan approval from <br /> ia Lie_2y99 q'At _ ,c\p C appliicca- township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ^" - ED <br /> tN1Y`� .A6t ET);•GoM 10.r-lZuccQ ;vsc4Sl6t--S.coin ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ❑ Elevation of property <br /> ilPARCEL frontage drawn to scale. <br /> NUMBER o(azicr�g-(4z- I,o2--d A-3 Q1.9 <br /> TOWNSHIP: SECTION: <br /> \IIF�2e -1 ?, I Lf '/a: 5E 1/41/a: /mil W ❑ Driveway permits <br /> ADDRESS: (state,county, town) <br /> 12.0CD E- q E-?--et'-1 AVE n <br /> CSM: LOT SUBDIVISION BLOCK/LOT I I Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (f-lc--m-t 2, S R.7.-1 i S c^ D4JE Co,..w..1 Tr cm.+-Ty —1 Zoning District <br /> . <br /> This project is a new building or structure.?„ 5/(,is Li Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANIT RY SERVICE: PERMIT NUMBER: J Rural Address <br /> EWER [EPTI (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> a a t_ ,,II 1 ❑ Wetland/Floodplain/ <br /> -�'� T Shoreland (attachment) <br /> ■REA TO N • 'EST SQUARE FOOT: <br /> (Outside dimensions including un in -. area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Q ❑ ErosionControl permit <br /> V 5,F 4, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST and available options. <br /> (Please round to nearest dollar) ♦ ♦ 1/000 <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? nYes EANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes nNo kalcifir, <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes nNo ? <br /> 5. Is this prc;act associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) . <br /> 6. Is a location survey required? (see reverse) 11Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes tiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ -+ <br /> 545-112(4/08) <br />