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ZONNG PERNIT PP CATIO , mc J n n SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> -",O/• 1--(' C'') tK.4 t-t ®Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> I 1 34 stir;To c.' i 1-i ( /- L l' i. •u I�,c)1•4 5 3 1 I 9 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> — 4,08'22 La,o554b Jvv-1%-1&orzt-cis.i..t C'c. .1--v.�r(... <ci..-‘ 0 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> CN1Zk-L-, Cq L-)a4r7t-i • .D H0 -t=_►z Ec�1..is, I I-4 c. Z Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> I 1 3 4 S.�K:-rc c;t r( t... .k ( P, 0, r,f x 14-3
<br /> (City,State,Zip) (City,State,Zip) Cgl Setbacks
<br /> M.:0 iZe:•,1-4 k:% T✓ 3 1 i `1 r3:_.sc:.14 F.c..tz1-1, ■ A 535/5
<br /> PHONE PHONE [8 Site Plan approval from
<br /> Co Of; 444 94 c1;9 e.,c, , 7 1.- 31t es applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> C L)A60, .t a 1-1,4 2 TER ua r H,.... X 42,,..�,0 5.. .. 6 l'i Nee c.0,,y g Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> nPARCEL 060(0 (i3 9 110 o tZ k •3 i . r, frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> M/tZC7Mi�t.;►I- t (p i/,, ,/4,/4 s Z Driveway permits
<br /> ADDRESS: • ^ / (state,county,town)
<br /> (Q_ t v MI Sanitary permits
<br /> CSM: LOT SUBDIV N BLOCK/LOT ry p
<br /> 1198 I
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION 'TAFF REVIEW
<br /> PROJECT DESCRIPTION:
<br /> 1-1 r w ra Ms i3O LiL,e.:E 4— A , y i U •oning District
<br /> ®This project is a new building or structure. Q tv ❑ Permitted Use?
<br /> OThis project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: • ' ra Address
<br /> EWER REPTIC V3, ZO t S 6 O 2-4-4- (ne existing)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including baseme )
<br /> M i I-I 106 M,�A. Z S' C, I-)E ❑ Wetland/Flo plain/
<br /> r Shorel (attachment
<br /> , �,-I ? AREA TO NEAREST SQUARE FOOT:
<br /> ( utsid Imensions including unfinished area,attached garages and above r decks or porches)
<br /> BASEMENT: 1ST FLOOR: ❑ ErosionCOntrol It
<br /> --IS .-j G ".-��� TOTAL SQUARE FOOTAGE: (slopes,dis ante,
<br /> 2ND FLOOR:_ 3RD FLOOR: a '�� O filling/a ss)
<br /> J ❑ R iew Location Survey
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ o,> and available options.
<br /> (Please round to nearest dollar) $z�-S;Oa�
<br /> OZ Sr 0 00 C e.cc, . ,ASC,060 a9i
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes No nDon't know
<br /> 2. Is there a wetland or floodplain on or near the property? EYes E(No ODon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? UYes nNo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ONo
<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) EYes EINo ODon't know
<br /> 7. Is this to correct a violation? nYes iglo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) ^ �� ,,r.� � (Continue on Back) ♦ -►
<br /> 1L �Oy.) 1
<br /> E /C_ I RAW'
<br /> r�I��" /O4OO
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