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ZONING PERMIT APPLICATION www.countyof ane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> tnArl ewe hPor-ter / 2 k ( "Cori- oning Status;CUP; <br /> WNER ADDRESS (Number,Street,City,State,Zip) <br /> llllll --�� y 3 �QQ�����aa,, eed Restriction; CSM <br /> �, <br /> HOME H9 E Hs! CELL P ONE Deer Pi E-MAIL ADDRESS <br /> , Lo Z 5-3 S 3/ V riance(# ) <br /> 08- !o - ..3-`s• ie Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1" . ifj 5 L y D,4,1/ S .-h sky ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> /20/ ,vt,4A/4-he Sdv f- 4.4.j BST- <br /> ( State,Zip) (City,State,Zip) Setbacks <br /> it jAdA,,s lc.dse w2 636'93 <br /> HONE PHONE 'ite P approval from <br /> &OR — crV 9— g 9lo y app• a wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dam. S e v .hDe4v a-,,,co,,.. • FIoor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wt.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: - •- O' • • operty <br /> jJ PARCEL <br /> NUMBER 024/07/Z ont-•' dr. r to scale. <br /> -- /03-8O8O-5" k N 1/ �3,3' <br /> TOWNSHIP: SECTION: / <br /> 67 I Q 1/a: s 4 1/41/4: 1\ 1 "141 Dn ay p -its <br /> ADDRESS: (state, ty,town) <br /> 73`/ Wwy B. ' ee ePel4 , w2 53531 pcs. •'tary per v s <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> S 6,14 , publi• vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> �A- o e Two Cots" a 4-p► rt ecg) , Zoning District <br /> This project is a new building or structure. Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U <br /> ❑SEWER PTIC 1 (ne /existing''\ <br /> HEIGHT IN FEET: NUMBER OF STmRI (Not including basement) <br /> loo P1 = �), S I w- or.•dpiain/ <br /> `� Sho - . attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> rosi.Con if0 rmIt 6-7 _6, <br /> j TOTAL SQUARE FOOTAGE: 4 (slopes rbance, <br /> filli •- -a.-ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 676., <br /> `' "eview Locatio <br /> ESTIMATED CONSTRUCTION COST: y <br /> (Please round to nearest dollar) ♦ -► ♦ "0 -0 ♦ $ a/00 a and available options. , <br /> �/ �" <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l�No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes t iiO ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes E1 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONO <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) ❑Yes I!SNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Eo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ <br />