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I SUPPLEMENT..ZONING PERMIT APPLICATION www.countyof• ne.com T to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME X4.14 <br /> /O.„/ 3fk.-'`-i°9 oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> ,a-0 G-4:0 1s0,,n ---b '- y T Cow.,,x. C-ui.•x 1,4)1 3 3 314- 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> e-3(7 lc-71r X Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ,� <br /> &J/4 UPcbe3v / �c 0/5 z>^-(, Site Plan including location <br /> AGENT ADDRE CONTRACTOR ADDRESS Of well/septic <br /> /0G/ s,�4.vK /�, S-T <br /> (City,State,Zip) • (Cy,State,Zip) Setbacks <br /> C G orrA ►r G.te i . ' s---..?_1 -7 <br /> PHONE PHONE Site Plan approval from <br /> 6 0. J-c j •.5-7_5"S— applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> .v,C L-).%�tir+:�s„ a aa.1 t,N: y Floor plans to scale <br /> ti <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) Elevation of <br /> PARENT PARCEL NUMBER: CURB TZON property <br /> G: ACREAGE: P P rty <br /> PARCEL �1iy f .ntage drawn to scale. <br /> NUMBER ��� l/�� a e� ,� <br /> TOWNSHIP• SECTION:�Gr.4-3,r1.�r 41c' A...6 I r 1/a: 'v f <br /> 1414: INI E Drivew. ..ermits <br /> (s - -,coun ,town) <br /> ADDRESS: <br /> 4.;1-e-S-0 CiV'CC-Jt�T C0: `:AGA -.1___c; ✓}S. , C---,-jr S. 3S,1 an' - , •ermits <br /> CSM: OT — SUBDIVISION 7 BLOCK/LOT •UbIIC • "vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> De1f/? ,L 4, n.,,c c," v,c< SA ii d o c-.A-li cl AS Aats r. oning District <br /> ❑This project is a new building or structure. ermitted Use? <br /> -- his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU /�' s Flu ' ei <br /> ❑SEWER _ EPTIC / (n` /existing, <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) R <br /> 11 W- . or;a sdplain/ <br /> AREA TO NEAREST SQUARE FOOT: r, (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST F R: ® ! ,_Qa f UM erirtit <br /> cr c ,l TOTAL SQUARE FOOTAGE: 4, (S ?e . �- 1 .? ..-, <br /> q till)n• ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> \1 Review k on Su ey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ , rid availab nS. <br /> (Please round to nearest dollar) • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑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? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) DYes :1 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Y:: E g;o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aros) (Continue on Back) <br />