Laserfiche WebLink
ZalNG PERIV■ 1 PP CAT ON SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME A-1 <br /> - <br /> e a A(21 E Litt Co T \ 1.�.A) iT1 £--t1-t t. -C-'4� Zoning Status UP• <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restrictio ,CSM <br /> Co y Q-D z-, SuN Qt �r•t� 3S U Vari.' - . ) i Z C� ] <br /> HOME PHONE CELL PHONE J E-MAIL ADDRESS <br /> j/11 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> L`i,v&i Der-LL. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic ti il i, <br /> (City,State,Zip) (City,State,Zip) gi Setbacks -0 c ,j <br /> PHONE PHONE Z Site Plan approval from/',,//^ <br /> 6,0E5 - a ( _ --,�33c, applicable township. r ,d- <br /> E-MAILADDRE S E-MAIL ADDRESS <br /> in A ,k{ A---th. - - MI Floor plans to scale <br /> l( <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER'' f RRENT NING: ACREAGE: Elevation of property / <br /> CIPN , /�/ r 3 2-` 'L ON—, � 2 , 0 3 •. ,.e drawn to scale. <br /> TOWNSHIP: N;, <br /> v^ 1k S +0 I SECTION;, +/4. Ai +/4+/4: Driveway permit <br /> {.� <br /> ADDRESS: (state,county,ay <br /> csM: LOT SUBDIVISION BLOCK/LOT %Sanitary p Its <br /> 1 2 i (public, riv ) <br /> PROPOSED PROJECT INFORMATION STAFF REV 7 /�C�i <br /> PROJECT DESCRIPTION: _ / 4// <br /> MOdfs C--c/STING �lGrvge tr `ti o � S-,DE ot= tZ.c�� J Zoning District <br /> This project is a new building or structure. �,/ <br /> p j g SFtm� Sir-t3.��� L,>� Permitted Use? / u St' <br /> This project is an addition/alteration to an existing building or structure. v _ /� v-� s-,‘, <br /> SANITARY SERVICE: ,��,�� PERMIT NUMBER: RuralAd. - s v h <br /> DEWER Ef EPTIC (new - isting <br /> HEIGHT IN FEET !�-`7► NUMBER OF STORIES: (Not including basement) <br /> / Wetland/Floodplain/ <br /> Shoreland (attachment) if <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 /> rosionControl permit TO <br /> /[i/•� + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, f <br /> 2ND FLOOR: 3RD FLOOR: _ flling/access) /g pf <br /> 3 ft Review Location SurviaA � <br /> ESTIMATED CONSTRUCTION COST: L�'/� o nd available options. <br /> (Please round to nearest dollar) ♦ ♦ -♦ ♦ ♦ .9 $ • i 00 <br /> 4 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ENo DDon't know �/ <br /> 2. Is there a wetland or floodplain on or near the property? EYes No LJDon'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 ONo <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 RN0 DDon't know <br /> 7. Is this to correct a violation? fYes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —0. <br /> 545-112(4/08) <br />