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ZONING �T A 'CATION�c �n SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ,t mfr\/ LA-V1/4^-V.......- 'L'"/ ❑Zoning Status;CUP; <br /> OWNER ADDRESS(Number,Street,City,State,Zip), _ <br /> k 5. (41: .e- J- (A-k-k-4-1 e_ L rDU� , 55 5�7 Deed Restriction;CSM <br /> �� ({ Variance(# ) <br /> HOME PHONE CELL HONE E-MAIL ADDR SS <br /> (>D 55g-I4 lZ (j✓o r d o j]Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,y4mFs jqc--7f /1/1,3 ❑Site Plan including location <br /> AGE`NI ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 79 r c E.v7 L /l✓.'. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan 1.p oal from <br /> Gel- -91-/-f1f(w)6eP-7Gt<-x,P5.3 w,) applicabl Vw/rei <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ..1Pec-fx/ .4.)d 'FSeo.‘eirc•:i-t�,.:1, ['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 /> E N EL G 1 <br /> .7 1 ^3c i _ 't52,) c---r/ f � frontage drawn to scale. <br /> NUM UM BER I <br /> TOWNSHIP. SECTIO : <br /> C c±>ilG.; G.ne,-� '/4: '//: 111 Driveway permits <br /> ADDRESS: (state,county,town) <br /> .970/ .S />/c°6. /e. ' C,4,-;- .1 ",,. �:---o:'E !J/ -fi x 7 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION ' BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 30 K -LI— "Tai.!• .e..?:n,J ❑ Zoning District <br /> . NiThis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC /✓fl (new/existing); <br /> HEIGHT IN FEET: , rIUMBER OF STORIES: (Not including basement) <br /> /j M 4I I i / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 2 <br /> BASEMENT: 1ST FLOOR: ❑ ErO510n('i0ntr01 permit J"7 i <br /> // /3 j 0 ,`TOTAL SQUARE FOOTAGE: ,+. (slopes,disturbance, Lam- �7 <br /> 2ND FLOOR: N 3RD FLOOR: filling/access)-. �� ! S—vr c�5 / <br /> ,VA ,c/-4 /...7. --.0� 1 <br /> 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ` and available options. <br /> (Please round to nearest dollar) --► . ' $ /4 G'0 e'`.) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I Yes ❑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? flYes 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) EYes gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1KINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -P -► <br /> 545-112(4/09) <br />