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ZONING PERMIT APPLICATION y <br /> .count ofdane.com <br /> SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME n nn J '}' <br /> c <br /> /� /? Proper-b i' / / &LC- ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 4if Deed Restriction;CSM <br /> P,o ' ybS/� Qd/S�'� ,a):7- 63 7W-?6/1/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL•DDRESS <br /> 0 2 )3! le he cu0/i ez) p Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT.' TOR NAME <br /> (}Q )- iI b WS/ ❑Site Plan including location <br /> AGENT ADDRESS CONTR•CTOR ADDRESS of well/septic <br /> Q.o? y5atoo P- , -B ay 'J6 2 <br /> (City,State,Zip) (City, ,e,Zip) ❑Setbacks <br /> PACO i5e)-,, oT 5 -)(11-1 / /9)7, Air 6371///-5-70 <br /> PHONE PHONE ❑Site Plan approval from <br /> l.QD�-l.I 41.1 ( Oa-73 -A, -W1/. ,2z7 3 applicable township. <br /> E-MAIL ADDRESS E-MAIL•DDRESS ,� " <br /> e_12( ZY'4-OtS 1 1 , ✓12}- 7 /X �//e/—�QeS. ,4ei ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE T ONING: ACREAGE: ❑Elevation of property <br /> ❑NUMBER 0-70g —3q1)- /. lx.�.�, I 1 .0 frontage drawn to scale. <br /> TOWNSHIP: nn 7 SECTIO : <br /> � '� a F !v� ;dd Cp� '/a: '/a'/4: ❑Driveway permits <br /> ADDRESS: n (state,county,town) <br /> ga-i a mid nr1 1 i d T�� Q4 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> .Z1' r),1 5W 1m in irn p(roI ❑Zoning District <br /> . ❑This 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: ❑ RttralAddress <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑rit EroslonC ©ntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4 slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/a ss) <br /> 6011 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -► and available options. <br /> (Please round to nearest dollar) `0t('C0 <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? ['Yes [ilo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ['Yes Nlo ❑Don't know <br /> 3. Have you talked with the township about your pro ect and are they in agreement? EJYes ❑No <br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? @Yes Llo <br /> 5. Is this project associated with a rezone/CUP/vari nce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ao ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 101\lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />