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ZONING PEFIVIT APPUCA11ON HW&County icianacoml <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> vA7 - 4 16 ATSe C12.-->`<`' ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 312"‘g 1-J >✓r.-Ko;zy T2-T-3) (=-•'": TZ-.D , 1/1/4)l .t \,V1 531/7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> VI- 35'1-/376 we e0i<v.sd , rnc‘../ CA.,...--1 ❑Site Plan draw o scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and inclu a dimensions <br /> AGENT NAME CONTR'``A''++CTOR NAME <br /> AGENT ADDRESS CONTRACTOR i d 1ADDRESS C,0- ✓V`�,S^ ❑Site l/s in ic ding location <br /> (City,State,Zip) (Ci State,Zip) Set S <br /> (CV,State, ?1,..;,,, WI S3S24 <br /> PHONE PHONE III Site Pla a�;;,�- Om <br /> (90Y—M - 0 3tosi applica f s'ip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> o✓c t/,1-1-4-c. ® "I L c5. n c--I- ❑Floor pla scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of pr rty <br /> 0 PARCEL NUMBER V�eLf(o0�- 0,11.- 90-75-9 p. 1 3. 2Z frontage r n to scale. <br /> TOWNSHIP: SECTION: <br /> T 06 Ni (Lo$ d L %4: '/4'/4: ❑Driveway er <br /> ADDRESS: (state, cduu Tty,/[o∎kn) <br /> 312 i f I k.>v7 11i J)4 I i.J w1 1 y , W 1 3 71 ❑Sanitary permits �j fe <br /> v sb 3 <br /> CSM: LOT SUBDIVISION BLOCK/LOT J I <br /> (public, private) C <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> / dd;rg 4cct»� ,i 17,,,((J._'y ❑ Zoning i s,Kct <br /> . EiThis project is a new building or structure. <br /> ❑ PermitJse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Cl Rural Address <br /> EWER rEPTIC (new/ex <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> �-1 ' 5 // " r A ( ❑ Wetl��in/ <br /> 1 Shor ttachment) <br /> AREA TO/NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I—, ErOSIO C rol It <br /> S[ 9 Le 4, TOTAL SQUARE FOOTAGE: 4, (si , rbance, <br /> 2ND FLOOR: 3RD FLOOR: fill g/access) <br /> IS 1 lQ ❑ Re .,S'isvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ b S and a il-• : •p ' s. <br /> (Please round to nearest dollar) $ t cs <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 12110 DJon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes LVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes alo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I;ave blank if none) <br /> 6. Is a location survey required? (see reverse) a E r i.:u[•Jl. <br /> 7. Is this to correct a violation? i� es VI o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> .rid-117(4iflR1 <br />