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ZONING PERMIT APPLICATION www.coun of a e. nt SUPPLEMENT to Web-App # <br /> . �► <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW►iffjt NAME K_/ / <br /> ❑ Zoning Status; P• <br /> OWNER ADDRESS (Number, treet,City,State,Zip) C�^C� Deed Res I ion; CSM <br /> S �� Variance(# ) <br /> HOME PH NE CELL PHONE E-MAIL ADDRESS <br /> 5/ as 20 ❑ Site Plan dra o scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CONT CT NAME <br /> fiC re; 'U 1 t %/ ' /C , CI j/kraut /II C ❑ Site Plan•'n ing location <br /> AGENT ADDRESS CONTRA TOR DDRESS of well/se lc <br /> 33/ /_ - 5 T <br /> (City,State,Zip) (City,State,Zip) ❑ Setb <br /> //i4 t/,.4,4 i •42.-12. <br /> PHONE PHONE El Site Plan -l p •//ii I .m <br /> w-5O - 4'6 'S c3 applicabl-l• -1.. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor pla s scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of Operty <br /> PARENT PARCELLNUMBER: CURRENT ON G ACREAGE: <br /> ❑ NUMBER 67=9F'-'34--'47`c°1-0 a -� •`-7 frontagt wn to scale. <br /> TOWNS/);7 ,-,Q SECTION: <br /> J�^ 1/' '/a'/a: ❑ Drive a! ,A1- mits <br /> �c 4' <br /> (sta /� town) <br /> ADD s F����. . 0 c sta �. <br /> CSM: ��� LOT SUBDIVISION L CK/LOT ❑ Sanit- per ,' s <br /> . �s'�. o (publi. p ' -te) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTI N: � t a <br /> is project is a new building or structure. Pitt , <br /> This project is an addition/alteration to an existing building or structure. <br /> ❑ P 1 9 9 <br /> SANITARY SERVICE: PERMIT NU B m + <br /> (SEWER SEPTIC <br /> e s <br /> —Zy ° CC � <br /> 5 <br /> HEIGHT IN F:78_ e NUMBER 0 STORIES: (Not including basement) <br /> . e )`' ,., <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 <br /> BASEMENT: 1ST FLOOR: 9 �3 <br /> �b 0 7 if /5 4, TOTAL SQUARE FOOTAGE: IF '� •-, <br /> �j 111 fihlin s 10;�... <br /> 2ND FLOOR: 3RD FLOOR: , <br /> (/ j =� k'0 a ft,Stirvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ 730,000 and , .;c017 g 3 <br /> (Please round to nearest dollar) -• f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes OTTO ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes acio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ars ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [ill <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) Yes ❑No ['Don't know <br /> 7. Is this to correct a violation? Yes [4Mo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -♦ <br /> 545-112(4/08) <br />