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ZONING PERMIT APPIJCATION SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> l n w IA o 4 C +ICS t;a KR ❑ Zoning Status;CUP; <br /> o *DORFSS(Nutter,sic camy,sap,Zip) Deed Restriction;GSM <br /> 7 ? 3 Kosk trite•: Rd. (tin�rc�, . WS S3S.1 ? Variance(# <br /> HOME PHONE CELL E-MAIL ADDRESS <br /> q 3- 3 14. ' S 76- /et)s ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indudes dimensions <br /> AGENT NAVE CONTRACTOR NAME <br /> �r e�q L)n tq <br /> (pug.. wr R s) dlo ti L Ct.el c✓ ❑ of Plan including location <br /> AOe well/septic <br /> 3 y L) Rd <br /> (City.SOL ZIP) ply,state.ZIP) ❑ Setbacks <br /> PHONE PHONE 1-9.1' S 35-a 3 Li Site Plan approval from <br /> JJJJ <br /> 1123 - 3316 <br /> applicable township. <br /> cola")• A mot++)ark. h e E�� ❑ Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wi.us) 13 EleVatiOnOfpr property <br /> PARENT PAWS_NUAE6t CIIiREIT2DN ING: ACREAGE <br /> ❑ PARCEL 0(12-2.22- gS Uo - 2 A/ / frontage drawn to scale. <br /> TOW IR SECIKIN <br /> C(1/7s rar►4 o 2 %: .V w %/.: 4I ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> 7 7 3 Kcskicera- R J. Car►b n./.9 ❑ Sanitary permits <br /> csa • LOT a SUBDIVISION BLOCKILOT ( ,per) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO.EC1i DE9C�il01t , A 1� .1 District <br /> Set i sh it S4ei ez;f it (2c n - a Tto' 4. 4 Mgt <br /> . yi This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing budding or structure. <br /> SAMTARY SERVICE PERMIT NUMBER ❑ Rural Address " <br /> ❑SEA kiaS8 T>c yk d s?? ( ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Nat i dudrig tiasen ) ❑ 'tlaf K�IRDO�tainl <br /> y,u " (ads) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �rCSiOrttr'�,,,ttrOt �.�rmit <br /> B I�SEABti 1ST FLOOR 4 Tow.SQUARE FOOTAGE: 4 (slopes,dlsti bad ce, <br /> 2143 FLOOR 3RD FLOOR <br /> 3000 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST . ♦ -► G and BIN to Op i ors. <br /> (Please round to nearest dollar) $ o S;DO 0 <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Di No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes II No ❑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? 181 Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) Qeave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ®No id Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPUCA1ION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -► <br /> 545-112( ► <br />