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` ZONING PERIVIT APPUCAT1ON wwireccurityorcianacom �•i��uu�a•;t .pit•:.t-t.a_i t•=,� <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O lGle%ateo( © I Stead OZoning Status;CUP; A. _1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 22-01— Cf� (+`''7 1- v2f•„ o�, t.S1 53.fg3 Variance(# ) <br /> HOME PHONE CEL PHONE 1E-MAIL ADDRESS <br /> 60$.22 3.92'0/ X0,9.4;, • 3o2 4 rIcI o 44--4.44 crow-c----6. c.i,1e,c-^^ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE T NAME CON, CTOR NA 0 <br /> I t b� �c iS ( tz,A.-, Site Plan including locatio <br /> GENT ADDRESS CONTRACTOR ADDRESV of well/septic <br /> if 8 2- MA.,r (4- S ,f I zo7 -a <br /> (City,State,Zip) (City,State,Zip) Setbacks C 3�3 o %o//r% <br /> A Adze-- � � 1s3s�z -_. <br /> PHONE PHONE Site Plan approval from /6” <br /> DS • ri s— - ( ( aS -9 applicable township. lfr44-- <br /> E-MAIL ADDRESS I E-MAIL ADDRESS <br /> -t Gµa t:6v, p po Is e -1--d5. .-..-+ O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) J <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL I �' , p 3 frontage drawn to scale. <br /> NUMBER dS 06o-7-Z31-C 20'D i5- O <br /> TOWNSHIP: SECTION: <br /> Ob y iY, d�l ¢ 23 1/4: E 14%: S 6- a Drivewa •-rmits <br /> A ESS: (stat-,co . ,town) <br /> 2 2_o4- 6 f-t i 111-4kAT J erom..«. I 1''S\ S" 5-1 3 11 Sanitary per. its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> los'9 5 Z (publieila - <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2 )( 31° ' ,-0, ,,44 rr e�o I Ira Zoning District — n <br /> . This project is a new building or structure. A I rcY <br /> Permitted Use? 1 ° <br /> This project is an addition/alteration to an existing building or structure. �( P©© <br /> SANITARY SERVICE: PERMIT NUMBER: Y?Rural A•. ess <br /> EWER MEPT1C (ne ,existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / ,�1 Wetl.!...2 oodplain/ N <br /> I ho elan. (attachment) <br /> A_ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: / tit AiyrosionControl permit--0 <br /> , TOTAL SQUARE FOOTAGE: 1, (slopes,disturbance, <br /> lf/ U filling/access)/// <br /> 2ND FLOOR: 3RD FLOOR: <br /> Review Location Survey,,f <br /> ESTIMATED CONSTRUCTION COST: -�► ♦ $ I €, f�00 ••i and available options. , <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? Res 'lo DJon't know <br /> 2. Is there a wetland or floodplain on or near the property? es o EJon't know <br /> 3. Have you talked with the township about your project and are they in agreement? �X YesVo <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# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Bo EDon't know <br /> 7. Is this to correct a violation? Dies 0 <br /> Ie 15 ...._ so APPLICATION MUST BE SIGNED/ (Continue on Back) —► ♦ ED( (2.—Sd6-117/d/OR�. //� S F e-- <br />