Laserfiche WebLink
ZOIVNG PEFIV1T APPLJCAT10• wow countyafdaie.corn <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OwNF,Sicc c e.-✓t Q <br /> JJ ning Status; CUP; <br /> OWNER ADDRESS (Number, eet,City,State, p / Deed Restriction; CSM <br /> l� 1-9 e .^0ol�l7n , C(// S 3SZ( Variance(# ) <br /> HOME PHONE CELL PHONE <br /> f E-MAIL ADDRESS <br /> 6�472`Y°(( • Ste►+. t1 etc?0pt•ber.c..,,) IZI›,Sittrrlan drawntoscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE/W.40,1E / COMB TOR NAM <br /> ( / 14,fa? 7, 0.'3 /v(Q. I t t, tv 1 S Plan including location <br /> AGENT ADDRESS I CONTRACTOR ADDRESS of well/septic <br /> ( -- '7 / pz Ovry l4 '4"--- <br /> (City,State, pi (City,State,Z ip) ebacks AA i��e N R W � �3 e Z <br /> PH NE PHONE/ ❑Site - .n -•.rovalfrom <br /> ,r'7 —C / o o 1 app .le township. <br /> E-MAIL ADDRESS, E-MAILAD RESS <br /> e I, 15 @ 424 F. ❑Floor . - . scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: <br /> d� CURRENT ZONING: A7,.., ACREAGE: ❑EIe,: o s,i•roperty <br /> NUMBER 0 I-2-o,`�/ Z + cooc l�44 -4 `J i G.-367 fron -.e • .wn to scale. <br /> TOWNSHIP: SECTION: / <br /> ��, on 61'2 ? 1/4: N k....) 11. S t ❑Drivew. -rmits <br /> SS: <br /> � (state, •.0 ,town) <br /> ADDRE <br /> Asi Au t r f. I 1 , , („3 \ 53-cat ❑ . permits <br /> CSM: Ae SUBDIVISION BLOCiVLOT (p .lic, • ivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DEtSCRIPTION: <br /> x 4-4' S(o O( ` ter oning District <br /> This project is a new building or structure. emitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT UMB R: 1 Rural Ad. <br /> EWER EPTIC (new/-xisting`' <br /> \\\\ <br /> HEIGHT IN FEET �• NUMBER OF OR (Not including basement) <br /> Wetland/ lain/ <br /> Shor-land (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Erosion .ntr. permi <br /> BASEMENT: 1ST FL <br /> j TOTAL SQUARE FOOTAGE: j (slopes, • rbance, ." <br /> filling/-. cess ar <br /> 2ND FLOOR: 3RD FLOOR: Vi?)0 <ir <br /> Review ocati urvey <br /> ESTIMATED CONSTRUCTION COST: i and ava options, <br /> (Please round to nearest dollar) Q('Q, <br /> i 1. The property is within 300 feet of a stream or 1000 feet from a and or lake? es o o�ow <br /> p P Y pond ❑`l <br /> 2. Is there a wetland or floodplain on or near the property? es o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes �o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑do <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 o EJon't know <br /> 7. Is this to correct a violation? ❑Yeslo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> S45-11 7,4ms <br />