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1396 )c- °?5 -5 --. / SSY
<br /> ZONING P ' MIT PPLICATI ltl
<br /> ON .count ofdane.co SUPPLEMENT to Web-App#
<br /> l ►� �`cc is • A C OTC✓
<br /> PROPERTY OWNER INFORMATION :. <;#' !_«".;h'.`r.,, - '' CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> �
<br /> M a� Ii .pb` -Q A1. i d : ,. 0• Zoning Status;CUP;
<br /> OWNER•DDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> • - ra,n- • ■ aiinllilir Variance(# )
<br /> HOME PHONE C' L PHONE E-MAIL ADD"
<br /> s,g a I– o 4 .4?c c6-l654 ►= Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACT•R NAME
<br /> Etta k2 5ti-V,eg,_ 1r-- 5Q,,Th-P _ b(Site PI in ing location
<br /> AGENT ADDRESS CONTRACT•R ADDRESS f well/ 'c
<br /> rr±U45 II - - . • • ‘cf< p
<br /> (City,State,Zip) (City,State,Z p) OM Setbacks
<br /> eidita....4 535er 1 ' --2
<br /> PHONE PHONE Site PI a oval from
<br /> eg_,3 `_©!3 cD /9--Yyt applica ownship.
<br /> E-MAIL ADDRESS E-MAIL ADD"ESS
<br /> ''",---_____ i Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi.usn ►: Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑ PARCEL r,c�..0_z u.5}k)- R_ --7_-E frontage drawn to scale.
<br /> NUMBER va C.n
<br /> •WNSHIP: SECTION:
<br /> SWas '/4: SF '/.'/,: nE �1 Driv a ermits
<br /> 11=t`2Lfl (stat unty,town)
<br /> ADDRESS:
<br /> 11 t LRSiz c_.--r I •-e U-17_5 35 ci a Sanitary•- mits
<br /> CSM: LOT t 6 SUBDIVISIO BLOCK/LOT (publ'' •"�-' �1 )
<br /> PROPOSED PROJECT INFORMATION `.� ;L ��
<br /> PROJECT DESCRIPTION: y } ,.
<br /> v
<br /> . is project is a new building or structure. ,i$r �
<br /> ❑This project is an addition/alteration to an existing b ilding or structure. Kt!, ,-_- m °,
<br /> SANITARY SERVICE: PERMIT NUM:ER: t A�°� T.g�,
<br /> ❑SEWER fiCSEPTIC ' '
<br /> HEIGHT IN FEET: NUMBER OF-TORIES: (Not including basement) r' ,=
<br /> ) F,4, :. -CI F
<br /> AREA TO NEAREST SQUARE 00T: -0'-'1:..--f
<br /> (Outside dimensions including unfinished area,attached garag-s and above grade decks or porches) t
<br /> BASEMENT: /7 1 ST FLOOR: '� e 4, TOTAL SQUARE FOOTAGE: 4, `,c i r' , ''''',,et''''''` «- % '�
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> AC16V*
<br /> ESTIMATED CONSTRUCTION COST: ,'000 �b$�r4Ir � ••std: ,r
<br /> (Please round to nearest dollar) �(� ,, , `,
<br /> 1. The property is within 300 feet of a stream or 1000 fe•t from a pond or lake? ❑Yes 1No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the propert ? ❑Yes ,No ❑Don't know
<br /> 3. Have you talked with the township about your project :nd are they in agreement? ,'Yes ❑No
<br /> 4. Has there been a zoning permit issued for this prope y 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 /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -+
<br /> 545-112(4/08)
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