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(,6 l 2-0 <br /> ZONING PEWIT APPUCATION vwnnntooltycfchaneoom SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME pp <br /> And+-<u £■ Pkel.pr N CCr-.1 A P . PkQJ s ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> -MS Sae rvsL. Tr1, M i ddlerv.,, WI 53562 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> coy- 533_0s-6z 608-333-9?335 Oephelps. 9c'te 3wta;(.cou1 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL o 3g/07 p8_0 6 Z-o 2761 k-I .471 7 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> i"1sdd1etotr, 06 '/a: Vw '/a'/: NE Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7S 6& Sal Li)t rvsk Trt•, Ill,t40-1)." <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary pe its <br /> 26 a—Plc-ha N7e4 (public, • <br /> Valle s I-es <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NQW Shed (hor ear4C1...d 9,-ti,,,.,1 ❑ Zoning District <br /> . EIThis 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: ❑ Rural Ad. - s <br /> EWER rEPTIC (n @W/- I°ing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> l '1, ( <br /> AREA TO NEAREST SQUARE FOOT: ❑ Wetland/ loodp(ain/ <br /> 1J Shoreland (attachment) <br /> (Outside dimensio including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> `b + TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 2 16 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 11 jj and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ U, y T� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ['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 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) <br />