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� SUPPLEMENT to.Web•App# <br /> w Y <br /> ZONING PERMIT APPLICATION ww.count ofdaf� om <br /> PROPERTY OWNER INFORMATION . . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ER <br /> .ke_i,.)e,--, _\' Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City State,Zip) Deed Restriction; CSM <br /> q a3 't 4w X15 \ hAsi. Variance(# (1--'Z- ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Coo" ai. as ) _ , )�S\-_LA, 5 . 0 f to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR:INFORMATION - ;; -nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> R e.t A_el.S c7Y1 ❑ Site Plax Inc Ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/scpt cc <br /> kJ 3115(P <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> iC(\OcTOsZd WI 5358(0 <br /> PHONE PHONE Q Site Plan approval from <br /> C003 55?) o Lk8 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION<:(http://accessdane.co.dlane.wi.us/)_: ;evation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: <br /> ElPARCEL / Q Q 8 frontage drawn to scale. <br /> NUMBER .3a,/n5)t -0q I- s -q °Z o:8 (p <br /> TOWNSHIP: SECTION: <br /> '/a: , , Driveway permits <br /> �lvR �c� /4/a' ' (state, county, town) <br /> ADDRESS: <br /> Q,Th ku. j 51 I Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT I <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Qn4& sk-KG. .OY1 kc nc4, Zoning Eract <br /> . Ej This project is a new or structure. ❑ Perml a• Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUfal Address <br /> r)EWER PEPTIC (new/e 4 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Q y ❑ S •dplaln/ <br /> lJ \ SF h o' 4:Ornent) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside climensioht.including unfinished area, attached garages and above grade decks or porches) <br /> ❑ EtO 9 . trot permit ry <br /> BASEMENT: 1ST FLOOR: `' <br /> 0 j TOTAL SQUARE FOOTAGE: ,, (sl.,„ ur.ante, t, <br /> l� w filly glaccess))IY 4 <br /> 2ND FLOOR: 3RD FLOOR: �. $Qe� tg r <br /> 1L t - <br /> 1. 0 ❑ Re' Lti'tlo urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► .4. --► ♦ d C an■ a • options <br /> (Please round to nearest dollar) Z .. : . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes JNo LDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ElDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes LjNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes 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) Des No ❑Don't know <br /> 7. Is this to correct a violation? L Yes Ii, o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0 -∎ <br /> 545-112(4/08) <br /> • <br />