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• <br /> InS <br /> ZONING PERMIT APPLICATION www.countyof ane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> IY11 +c)91 <br /> di Alik.I+ 5p(eelfwe_____ <br /> OWNER ADDRESS (Number, treet,City,State,Zip) <br /> OCling Status; CUP; <br /> Vr7 a G� l�e 2 V eed Restriction; CSM <br /> HOM/EJPHONE CELL/PH , eW E-�LADDRES ro k 10 ' S 3 9 3 Variance(# ) <br /> 5 5- ./I5 975-2135 M 5 ' re hercT 8 S• . Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME,. CONTRACTOR NAME ,�, ��r <br /> wN�"_ -)) 1 II` Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> of well/septic <br /> (City,State,Zi (City,State, ip Setbacks <br /> PHONE PHONE / ❑ Si pproval from <br /> appl• ble wnship. <br /> E-MAIL ADDRESS <br /> E-MAILADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT}�NING: ACREAGE: P P y <br /> NUMBER - 1 ' ' .- �-(�' — I �5 frontage drawn to scale. <br /> ice-�-- <br /> TOWNSHIP n n L SECTION: <br /> i �T�ll� '�4: Y4'�4: ❑ Drive rmits <br /> state u ,town <br /> ADDRESS: <br /> 759 /ley VIew RI ( town) <br /> sermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ - - <br /> (pub• , . ivate) <br /> PROPOSED PROJECT INFORMAi iUr STAFF S ; <br /> PROJECT DESCRIPTION: <br /> a x- r C A4 vY/f 2x21��-Q $,le. Zoning Distric - try , <br /> This project is a new buildirrg or structure. <br /> A`Permitted Use <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: /) UN� PERMIT NUMBER: <br /> Ur ` " 4 <br /> 13 SEWER r U SEPTIC �n,fNf85CIStFri ) <br /> HEIGHT IN FEET: / I NUMBER OF STORIES: (Not including basement) i <br /> /� _/D 0 Ye • e tBgdplal tl s <br /> AREA TO NEAREST SQUARE FOOT: <br /> Sh a ' (attacthmentt ` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ <br /> BASEMENT: 1ST FLOOR: �rQSf ° tTQ)l'OGnn! e <br /> GE: , (sop , J Cb 1 ,7� Q � 4, TOTAL SQUARE FOOTA fIIln• ac ) ' ,A V aive <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Revie atton Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -i ♦ an a)lab options <br /> (Please round to nearest dollar) /��a� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? U .ENO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ja'No ❑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? ,Yes ❑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) <br /> U �'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1allo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -► - <br />