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i <br /> 4y <br /> ZONING PERMIT APPLICATION www.count o a e.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �t <br /> t)i 50 Y <br /> - ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> aZI ( lenahirx3 4 Lt ii 0144jjSPAiO 1.13-L 53711 Variance(# ) <br /> HOME PHONE CELL PHONE E- ILADDRESS <br /> 4 ti 7 4 7 ZD ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR <br /> NAM E <br /> /Ir,() t Y <br /> 4 I kt /61_')- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRE S <br /> of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> c )0►Z-l' GO 10_se_u.) Lc <br /> PHONE PHONE ❑ Site Plan approval from <br /> (e01 ?.S —2'8'01 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 7-it)/Z_ i-t)L5'0 G4 )742 S 1 tu-ei ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: ❑ Elevation of property <br /> Li PARCEL /tGOS_ Z1YI_S(20--Y P <br /> NUMBER Z 2 [ , 2 frontage drawn to scale. <br /> TOWNSHIP: SECTION' <br /> -8 VW"f_ �``� 1/a: NE_ 4Y%: /U W_- ❑ Driveway permits <br /> ADDRESS: ,�} {�r 3 (state,county,town) <br /> CSM: 1, n' Lcr `�' � SUBDIVISION BLOCK/LOT <br /> ❑ Sanitary permits <br /> "7z(Q (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: - <br /> Y./n <br /> `e -_&s ❑ 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: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FL ❑ ErosionControl permit <br /> L/ 9 J` 0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: �/ �r <br /> filling/access) <br /> 5 1 q1 1$C -C"?. I ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ o and available options. <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 ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑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? ❑Yes ❑No <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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> 9tAPPLICATION MUST BE SIGNED 7 sas-ii2(4/08) 0 v (Continue on Back) ♦ -∎ <br /> e <br />