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ZONING PERMIT APPLICATION www.coui a com SUPPLEMENT to Web-App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Sc h ail /4 A dd £ V ,ck, 1..._ Zoning Status;CUP; <br /> OWNER AD}RESS(Number,Street.City,Ste,Zip} Deed Restriction;GSM <br /> S:14/2 /d''A RJ �c e-A h7.. 4/5'12f Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 106 7k6 ff 2 f 1 Sc, ✓ ,, C ha•?P•A'9.. A/e7 UiSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ✓'p MG n C!iry ;,✓cl,0, i LI Site Ptan including location <br /> AGENT ADORESS CONTRACTOR ADORESS I Of we (septic <br /> Al ,x,17 7 S C,,elc.,J /ed <br /> (ter sue,Z). tom,sue,ZIpt Setbacks <br /> Frr 191/(ia..Q, Ai: KI s.le <br /> PHONE PHONE 0 Site Plan approval from <br /> 666• 2e2- IS 73 <br /> pplicable township. <br /> EMAIL ASS E-MMLADORESS <br /> Floor plans to scale <br /> PROPERTYLOCATION INFORMATION (http:'.accessdane.co.dane.wi.us,) Eii Elevatian�property <br /> PARENT PARCEL Nth: CURRENT ZONING ACREAGE: <br /> u PARCEL <br /> NumBER 0 C 12- 272- &210- 0 2 t-t - ( 9T2 2. 1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: 1 P+ <br /> 1 , i® Driveway permits N <br /> C�j v".I�An ti 27 /.iI/EoA /V4/ 4%: (state,county,town) <br /> Aoscs- //�/ n <br /> 6 l �S( td / I 64,,i' 4 W ,c33-21 - sanitary permits <br /> Cstt I,OT SUBOMS BLOCK/LOT ! (public,private) <br /> PROPOSED PROJECT INFORMATION 1 <br /> PROJECT DESC AL <br /> .::) -Rs Q Zoning District <br /> . KS This project is a new building or structure. Q Permitted Use? <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT (NUMBER Q Rural Address <br /> 3 SEWER al SEPTIC L/7`l 7 1 ( <br /> HEIGHT IN FEET NUMBER OF STORES- (No(inctudog basement) <br /> 2 S- 2 ❑Wetland/Floodplai / <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Q EionContrd permit <br /> BASEMENT: tST FLOOR TOTAL SQUARE FOOTAGE: (slopes.disturbance./X12 �C'�60 ♦ <br /> filingfaccess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1106 !-7 <br /> / 7 2 LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► -�► and available options. <br /> (Please round to nearest dollar) ,�"d` 0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 61No CIDon`t know <br /> 2. Is there a wetland or ftoodptain on or near the property? ❑Yes ®No U Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? iiiiYes :.s 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 Q No ®Don't know <br /> 7. Is this to correct a violation? ®Yes ®No <br /> 3 g APPLICATION MUST BE SIGNED <br /> (Cantinas on Back) -, -► <br /> 5415-112(4/03) J �• t-/ ;='" <br /> , 5 ,.,,,,., „ . <br />