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ZONING PERMIT APPLJCATION vwwutootxltyofdar>e.00m SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,/� <br /> $h4ih I{ 1' 1' /` <br /> /Zoning Status; CUP; <br /> OWNER ADDRESS (Number,street,City,State,Zip) Deed Restriction; CSM 2-1 / 3 <br /> 552.0 Wh rn4g ILL Oregoh WI 5354'5 Variance(# ) <br /> HOME PHONE CEL PHONE E-MAIL ADDRESS <br /> tv08 - I- , ; L SKC,t►>tv►ri5 dg .lIll►o•cogm. im Site Plan drawn to scale`-? <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions c o <br /> AGENT NAME CONTRACTOR NAME <br /> Se‘g tleCtl elf. P5 C44,0 (40,■5 ris. I'LL.. ©Site ' -• '.• luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> 1431 !Jaw 4�, a• (45( - a <br /> (City,State,Zip) (City,State,Zip) ' a/ Setbacks 3Q/15//© / <br /> ftd i soy t 01 5 3 4.03 WAd S(M L WI . 5 31'03 <br /> PHONE PHONE Site Plan approval from ,{ <br /> 660 -2A —33i+ (�06 . 209 3 39 - applicable township. /" fl- <br /> E-MAIL A•RES • E-MAIL ADDRESS Floor plans to scale <br /> T& _:..J u•, !► T�s cKs�trtlrtG41W1,��,n. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ®Elevation of property <br /> NUMBER 01040501 -1411-20I-0 -I q.Z frontage drawn to scale. <br /> TOWNSHIP: SE/TON: S �r ' ' NIA/ <br /> Driveway permit Teton Or o/t '/a: - /s/s: <br /> ADDRESS: / (state,county ow <br /> 55W 14;4419;414 I4 y Or i 1i 443$1,0e- 53 5M X Sanitary :o <br /> CSM: LOT SUBDIVI ON BLOCK/LOT (public • <br /> 51 Will ri•Iy2 $/ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR EC DESCRIPTION: / / ' <br /> foot r.o0w4 P iIN1 2 2 )( Z 2- /8 (x/ 6 e k ,Zoning District - 1 23 9) <br /> . OThis project is a new building or structure. j Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: KEPTIC PERMIT NUMBER: Ial •i• -EWER ( a'HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> j _ 4 , I { ' •. _ ••••.saint <br /> •.•L 4,6 (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outsi•; dimensions including unfinished area,attached garages and above grade decks or porches) nCotltrot ttTlit <br /> - - • 1 ST FLOOR: <br /> 4 4 TOTAL SQUARE FOOTAGE: 4 r"'"','-(slopelt,distu ncee, <br /> 3as•�teete- Pele k• <br /> fill ngta ess).., I` <br /> -�-�� it 9$ ell. nd Resew Location survey Ar 1 <br /> ESTIMATED CONSTRUCTION COST.' <br /> -♦ ♦ -p ♦ -► $ OD D©e D and avails options J• <br /> (Please round to nearest dollar) 4� � t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes IENo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes Lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DJeo DNo P•ls;WY G <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) Dyes 'lo ['Don't know <br /> 7. Is this to correct a violation? Dyes No <br /> -zz f `4 y ?S80 SFI <br /> .Z Z . i , ,.I APPLICATION MUST BE SIGNED <br /> L /2 ." _ (Continue on Back) -► -► -► <br /> 545-112(4/08) <br /> yr:7_15,1+75e.---A • S /Olt / <br />