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ZONING PERIVIT APPLICATION wuwicartycida iacfl 1 E1'I a ar,i a: ��•�.c •�_,•�•::� <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> E r t,c l 4vi 6t.ti A 6Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, ,Zip) Deed Restriction; CSM <br /> I✓ 'l c lit„vCii , Cvli4 c L,vOVei /A-7t".. ,535.4.7 Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL ADDRESS <br /> ,Z 3+ 0 ' ✓"Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 7&i L_4M In eytscui ' eilICky 4404a5C ?3i,,1e('44-% EiSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1204 Wr pit Ise - s g. Linge1ai.a h•ei- <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Veeo144 , 0 - 53513 L44 •,;r<e 'i . 5 35-?° <br /> PHONE PHONE DSite Plan approval from <br /> 2 3 S - /$ (P 4, Z 3 Ste, l8(0(b. applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERT Y/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> 0NU <br /> NUMBER °(Dill(¢�fOS(of -2 Si Qj(� frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> *1(15.S ® riveway permits <br /> 644 /4: //: (state, county,town) <br /> n)ADD <br /> 'Z(S 1 C 4(4 1/ 6i-• CO £- ��/�� 4anitary permits <br /> CSM: LOT i UBDIVISI N BLOCK/LOT <br /> O � ( ?o (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> f4' ic 2 0 ' 'Det4LkPd 40,4 y-e i Zoning District <br /> . CRIThis 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 /> [)EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ` 0 I/Floodplain!/3 nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ ECO ontrol permit <br /> TOTAL SQUARE FOOTAGE: ,+, (slo isturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/ <br /> tBC) ❑ Revin cation Survey <br /> ESTIMATED CONSTRUCTION COST: -0. ♦ ♦ ♦ ♦ ♦ l37� Q.O. and le 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? fres ao aon'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? DYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres L'Io <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) Ekes No DDon't know <br /> _ <br /> 7. Is this to correct a violation? Efres No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -♦ <br /> S4S_119/AMR\ <br />