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-Room i(0 <br /> r---2 / 4 a i 0 MLK brr,ic- <br /> ZONING PERMIT APPLICATION www.coulntyofdalne.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> Roy\4-Sha.tltl,er\5 ir►1.` t-h b:t'�te r ❑ Zoninstrict <br /> OWNER ADDRESS (Number,Street,City.State,Zlp� <br /> .PHSIE 1 i L t I 01 �'al/ M.� E-MAIL ADDRESS ❑ Perr iti@d Use? <br /> ,c3(0 -6)3(/ ❑ Zoning Stat s;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Ction; CSM <br /> AGENT NAME CONTRACTOR NAME Vari ce(# ) <br /> Gi t` 1 CU j\fl4 'we Ace(144.s 4 el .Co n s t-rk.k.c ha. <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> �i►oE IvY►wcctlCtr k;, ❑ Site Plan wn to scale <br /> and i udes dimensions <br /> (City'ale,Zip) (City,State,Zip) <br /> CAYCSS p 14t ►■-t tO% S Z>< <br /> VPHONE Site Plan including location <br /> PHONE "\_ <br /> 1'1 k_�eo I fwell/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Se Cks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan ap oval from <br /> PARENT PARCEL NUMBER: ZONIN% ACREAGES <br /> : <br /> ❑ rriASA 038/0101s-09 - )34 S 4. ,.- J <br /> _ applicab ownship. <br /> TOWNSHIP: SECTION: <br /> (Jl ddletov\ 05 '/4: /VC %h�4: Nsi ❑ Rural ess <br /> ADDRESS: (new/ rsting) <br /> 55441 Ellin) fen Wcul l ( liC lei iv 5350 ( Floor plans to scale <br /> CSM: LOT SUBDIVISION BL OT <br /> 3`t • Stclubruci6-Zsiaks ri <br /> .co Elevation of property <br /> PROPOSED PROJECT INFORMATION rontage drawn to scale. <br /> PROJECT DESCRIPTION: i <br /> Sereenea.t Percl -01'1`• l 1 Li Driveway its <br /> . ❑This project is a new building or structure. (state, unty,town) <br /> ( 'This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary its <br /> SANITARY SERVICE: PERMIT NUMBER: (pub• ,private) <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET 19 NUMBER OF STORIES: (Not including basement) ❑ Wetland/FI dplain/ <br /> Shore d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionContr ermit <br /> BASEMENT 1ST FLOOR.,- �� <br /> S Q 1-.)<2ND FLOOR: 3RD FLOOR: j TOTAL SQUARE FOOTAGE: ' (slopes, urbance, <br /> filling/ cess) <br /> \J'/�„ ��� Re 'e on Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ e�' nd av • le options. <br /> (Please round to nearest dollar) $ l 8 f . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes GINo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes [ No Li Don't know <br /> 3. Have you talked with the township about your project? Ct?'Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes L lio ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes [ No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(1108) (Continue on Back) -i -+ -► <br />