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SUPPLEMENT to Web-App # <br /> ZONING PEIV IT APPLICATION www.coutyoofdar>le oom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME �^ / <br /> RICA-f ►211 L i� .T, 13/t-v, S g x <br /> L Nl�i�/ Zonin Status; CUP, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /, Deed Restriction;CSM <br /> . ✓c 62- S i i -r= P-1) ,St c ) 1p2A-14 e: WE 5.3 5! d Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0; .3 - . 1).- Go 8- 2-57-2 to 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -TAO ti 1.C(, A Site Plan including locatio <br /> AGENT ADDRESS CONTRAC R ADDRESS of well/septic <br /> '7>-2 S, 13/RteSEy 5 Dl2S���!'v <br /> (City,State,Zip) (City,State,Zip) 074 Setbacks / <br /> cot t.w,t cs 104- s�q-5 <br /> PHONE PHONE t ' tg Site Plan approval from NA <br /> 6O o •42 i5- D 87g applicable township. /� <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEUNUMBJR: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL �+ G� -C frontage drawn to scale. <br /> NUMBER o�1 - 7- ggj { _ ( 1 •' <br /> TOWNSHIP: SECTION:w lZ ' �►�� Driveway permit <br /> S N l-ty .Si v i 4-t l l E .2/ SvV/4: S.up- /</4:N, <br /> ADDRESS: (state,county, ow <br /> 3 62_ 5 7A-aL r ti P S L Ai Pnits i2)E tt.rz 6-3 9 0 Sanitary p.emaits <br /> CSM: LOT 4 SUBDIVISION BLOCK/LOT <br /> i:5 (public, vat <br /> 5'CW( it <br /> PROPOSED PROJECT INFORMATION ,/ STAFF REVIEW <br /> PROJECT�E f cIO* el ec r� c-A L +D S(r /� 1 K /6 2_ f- ti6oning District 4 /E- <br /> . ❑This project is a new building or structure. cT r G <br /> S Permitted Use? Q <br /> QThis project is an addition/alteration to an existing building or structure. A .')K <br /> SANITARY SERVICE: PERMIT NUMBER: �i Rural A S <br /> EWER [EPTIC (new xi in <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Notjncluding basement) <br /> Z, - -•• ••dplain/ N/� <br /> AREA TO NEAREST SQUARE FOOT: hOrelan• .chment) Al/ <br /> A1-- <br /> dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: arErosionControl permit <br /> / 9 I TOTAL SQUARE FOOTAGE: I (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ^ <br /> 7 Review Location Survey A'/k <br /> ESTIMATED CONSTRUCTION COST: 6 7�o oe 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? ❑Yes Eirlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des Dlo ❑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? ❑Yes [ o <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 to ❑Don't know <br /> 7. Is this to correct a violation? []Yes ❑j too <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) = = = <br />