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ZONING PERMIT APPLICATION ww.countyofdano.com FsuPptEMENr to.Web App;#:; <br /> w <br /> 'PROPERTYOWNER INFOR MATION ,;;. ;,-:;1-::---,:::: ','"';:;;:.,;--':-:, -j1: :," ' ..? F.: CU TOMER TO PROVIDE <br /> OWNER NAIVIE <br /> (-4 Q_cm.) L ' Li eAs-e) ` Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip <br /> ,7 C ib Q elk, \a 1( ` (� ' I�y p„ �l T Deed Restriction; CSM <br /> HOME PHONE CELL PHONE AIL ADDRESS `+(�- <br /> /C�.5 '�31LI A■ 'E��skt.... 0 'il`r�t eTI�Sv 'NE} S. ePlandrawntoscale <br /> AGEN.T'INFORMATION • CONTRACTOR INFORMATION, z : 41- d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Site Plana oval from <br /> applic towns • <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor s to scale <br /> ;PROPERTY/LOCATION;INFORMATION'-'(http a//accessdane co,dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: ❑ Elevation Of property <br /> ❑PARCEL SC 6- 3 14_q/ - .t 17 , a outage drawn to scale.■NUMBER <br /> TO HIP: - • SECTION:- <br /> •(N(N 3 1/4: ---- '/a'/a: Driveway permits <br /> ADDRESS (state, county, town) <br /> N alltN/11)61V Uct\t ' e Lo- ---s5 7 • Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> • blic, private) <br /> PROPOSED PROJECT.INFORMATION <br /> . - TAFt RErlIE11V <br /> PROJF DESCRI TION: / i <br /> U t l d`t `fl. c "/ �o� omng Dlst 4: <br /> t ' t r d�-�3� .a �X � { <br /> . fJThis project is a new buildin or structure. <br /> Permitted <br /> This project is an addition/ teration to an existing building or str ct re. <br /> S T ] <br /> SANITARY SERVICE: PERMIT NUMBER: ,1{A`\\, 4Q.�Rural A+dr s5 <br /> !- 5 4 <br /> EWER EPTIC ,�;� ti�Tlewk 1Iflg� `" _ <br /> HEIGHT IN FEET NUMBER OF STORIES: (No i ludin basement) - <br /> If S _ 17tV2 C i Wetland/FI`e••plain i <br /> ,oivea'•,I.attacpm <br /> AREA TO NEAREST SQUARE FOOT: Y` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: CosiConr•�•eCfidlt N.S" Q±), <br /> j, TOTAL SQUARE FOOTAGE: 4, ' si13 S S ° rba i ; <br /> 2ND FLOOR: 3RD FLOOR: �✓ `� fjll`ftiljFtae, $$ r " r <br /> Yom) C] e-ing b.aation S,oey <br /> ESTIMATED CONSTRUCTION COST: " 1° T y ` x <br /> . aid a„,„:„.fie ptrcns. <br /> (Please round to nearest dollar) "� ♦ ♦ �'� © 0 © - ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Eyes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> ,.. 00 APPLICATION MUST BE SIGNED <br /> N (Continue on Back) —■' —► —9 <br /> 545-112(4/08) . <br />