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Air RA SS Li a �- -y Cana- �y �_ y �� S ox o <br /> C l SOS <br /> �� j 6 (60—,t( <br /> am: -Zv l <br /> ZONING PERMIT APPLICATION www.cou4riake.com SUPF,LEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAM J ' / /-' <br /> kirk a l Ekgr ing District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) S-3s�-p <br /> I S' 81,,,,_ S_ I.-m.4,e_ Li& A4 ,,,Si 1I/ , IL, .u I ermitted Use?4 4 <br /> PHONE f a 5j.‘J---z---10 18" E-MAIL ADDRESS <br /> V , " O oning Status; CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRA TOR NAME <br /> Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADD Plan drawn to scale <br /> (City,State,Zip) .. c....'-' <br /> (City,State,Zip) Lisa <br /> and includes dimensions <br /> PHONE a Plan including location <br /> PHONE Of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ©-Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ite Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: 'CREAGE: <br /> ❑ PARCEL applicable township. <br /> NUMBER 0.SW° l/l-'f4,t-SIOCe 7� -jI 1, �S <br /> TOWNSHIP: SECTION: (y Rural Address <br /> ADDRESS: NW 1/4: /�►W 1/41/4: (n /exis <br /> Q Gon p <br /> �'/ D I Y� k V. 14.1.oor plans to scale <br /> CS LOT SUBDIVISION BLOCK/LOT <br /> Of - 1 I`f�'I E ation of property <br /> PROPOSED PROJECT INFORMATION 'frontage drawn to scale. <br /> PROJECT DESCRIPTION: pb ,� S IMF <br /> -.0X, )--/'a/chi-ton d-r, /1i F. c3, v- eX:)Ski 614,, rivew per ' <br /> ❑This project is a new building or structure. (stat ,town) <br /> i4his project is an addition/alteration to an existing building or structure. <br /> 1.1..Sealm Its <br /> SANITARY SERVICE: PERMIT?lU <br /> ❑SEWER SEPTIC N (p , Vate) <br /> HEIGHT IN FEET: NUMBER F TORIES: (Not including basement) <br /> ' <br /> Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> a 0 k .�7 + TOTAL SQUARE FOOTAGE: j slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> S. � view Location Su y <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -4. ♦ nd available opti ns. <br /> (Please round to nearest dollar) g <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes St& ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Y's ❑No 0 Don't know <br /> 3. Have you talked with the township about your project? LidYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 2/No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank ii none) <br /> 6. Is a location survey required? ❑Yes N <br /> U,,d//o ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes 12/No <br /> 5 APPLICATION MUST BE SIGNED <br /> 545-112(1/08) <br /> (Continue on Back) —► ■ -i <br />