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ZONING. PERMIT APPLICATION www.countyofdanc.com =SUPP,LEMENTto Web�App# <br /> 'PROPERTY*MEW 1NFORMATION ,��,. t; s�-- _r= a.t:,*5r '. i aWr `, CUSTOMER TO PROVIDE <br /> OWNER NAME �, • <br /> ,/� t) ( N / ' ► t l e �- 'Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 7/ /)cp zTc9 04-- - /- Kt- `e Variance(# ) <br /> HOME P ON CELL PHONE E-MAIL ADDRESS - <br /> 0 g ✓ 07 ♦?i n Site Plan drawn to scale <br /> AGENT jINFORMATION ,; z ti 3s #61-0 CTOR INFOR IWgTTCriga {17; and includes dimensions <br /> AGENT NAME COT CTOR NAME <br /> � ..1 _C/ R/ / /7-e- , n Site Plan including location <br /> AGENT ADDRESS ONTRACTOR ADD RESS of well/septic <br /> / ? 9 ( >)t,QJ;2 4 /9- <br /> (City,State,Zip) (city,State,Zip) ❑Setbacks <br /> 5 w . P12 rL4/2le <br /> PHONE PHONE n Site Plan approval from <br /> /„ d Q' g-0 r q 7,I . applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS - <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORNIAT 1ON>.(http,//accessdane.co,dan_e:wi.us/)V " - <br /> PARENT PARCEL NU BER: .• CURRENT ONING. ACREAGE: ❑Elevation of property <br /> 0 PARCEL /'�Q/ ! ?B SC ' frontage drawn to scale. <br /> NUMBER (/{% ! / ��3�0 v <br /> TOWNSHIP: SE oN. ❑Driveway permits <br /> 5,.A., ?walk:.� -3( '/4: '/4'/4: (state, county, town) <br /> ADDRESS: <br /> 7( l7 c9 v, <br /> CSM: LOT SUBDIVISION BLOCK/LOT [II Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> r . <br /> PROJECT DESCRIPT�I/O'N: � - � - .` � O�� �y.�'" . 74 '� <br /> i Di s s . <br /> . ❑T ject is a new building.or structure. <br /> his - � ° .4'� <br /> his project is an addition/alteration to an existing building or structure. f — M <br /> SANITARY SERVICE: PERMIT NUMBER: _ 5A e eS m ,_ <br /> . FIEWER PTIC e P . 4t, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not' cluding basement) -_� 4 -` , <br /> . .'7 Cr . e 113o�F oc delalrVir <br /> • ti( Bny ar <br /> AREA TO NEAREST SQUARE FOOT �__. _'� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ''�'- ' *1 = - <br /> BASEMENT: • 1ST FLOOR: _ � ; �- �, <br /> .-� ' 4, TOTAL SQUARE FOOTAGE: 4 13 8 r -'ir, <br /> 2ND FLOOR: 3RD FLOOR: s= _s — a; <br /> v <br /> • �� ` -- , <br /> e e:a eta � <br /> ESTIMATED CONSTRUCTION COST: ,, .ItE- e �- ` <br /> (Please round to nearest dollar) �� ♦ ♦ � l f 5-;9(') 24--------,-_---- ---t-'" - :_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes to ' Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Ye o .❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? aes ❑No _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L" . <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) [Yee l4 P4 . ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ENO- <br /> . <br /> APPLICATION MUST BE SIGNED <br /> • (Continue on Back) -0. -9. -0 <br /> 54S-112{4ro8) - <br />