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ZONING PERMIT APPLICATION .countyotdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OVER NAME <br /> ( FE ALD AA*WE R-47 o'`) El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction; CSM <br /> rj2 Co. 1-4v1Y / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ( -l01-0-i!)623 ® Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> .Arioe. - V-.2.a-r z E. .r--P-AT z-J. © Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> 44 ( PACK Arils y-1 PAA24. RITE <br /> (City.State.Zip) (City,Sta Zip) ® Setbacks <br /> PP.AiR-ii_- au SPCC., w( i67& Aaczii� (I:, S AC,0i 53M <br /> PHONE PHONE ® Site Plan approval from <br /> 608° y 12. 902,2- 1005--512_ -gOZZ. applicable township. <br /> E-MAILADDRESS E-MAIL•'DRESS <br /> jinnkratz. decl•i'lcie0ottnc+II e.v - Idwkratzeciecie ias&hoi-,K+a11,Lon 12 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER CU AWNING: ACREAGE: Elevation of property-0 N PARCEL <br /> MBER D O /V -9,?20 13!6 frontage drawn to scale. <br /> le. <br /> TOWNSHIP: SECT:t ' 6 \ s , C Driveway permits <br /> �07c�,U�`� �' V\) �`�''J w/w (state,county,town) <br /> ADDRESS:(� 5 ( O " <br /> 7 e, © Sanitary permits <br /> CSM: LOT n SUBDM-ION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 3 F <br /> 0 ❑ Zoning District <br /> . [ This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existi g building or structure. <br /> SANITARY SERVICE: PERMIT ' ❑ Rural Address <br /> Q q 0 3 EWER 1- 4gPTIC (new/existing) <br /> HEIGHT IN FEET NUMBE"OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> 1 Ca)‘- i 0" Shoreland (attachment) <br /> AREA TO NEAREST SQU°RE FOOT: <br /> (Outside dimensions including unfinished area,attached g rages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> disturbance, <br /> 2 3 ( � j TOTAL SQUARE FOOTAGE: ,, (slopes, <br /> �} g�j filling/access) <br /> 2ND FLOOR: 3RD FLOOR:0 .0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST 1 © (� and available options. <br /> -► ♦ -• -► 1 v <br /> `(Please round to nearest dollar) / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes E io ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [yes o [Don't know <br /> 3. Have you talked with the township Y <br /> townshi about your project and are they in agreement? Eres ilo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Drea Elisio <br /> 5. is project associated with a rezone/CUP/vari ance(petition/appeal# ) (leave blank if none) <br /> 6. IsaItion survey required? (see reverse) Dyes Epo ppon't know <br /> 7. Is this to correct a violation? Cues [Jo <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) -► -► -+ <br />