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ZONNG �T APPLICATION ww�u � , SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNE IMEr I <br /> S ki` C l 4 Zoning Status; CUP; — I <br /> OWN ADDRESS (Number,Street,City,State,Zi <br /> O y /2 G1 Deed Restriction; CSM �-3 <br /> HOME PHONE '` (' ��L PNL � �� MA LADD1 `�3�6 2 Variance(# ) <br /> .�, - • — .S F-►+�� c r►ik kc$ o. _ r. ®Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME r CONTRACT R NAME <br /> Oc.c /Q t OS-10 me Coo, �,Gr t; (.1 r s 13 S. - :-• .1 cluding location <br /> AGEfJTADDRE � � �� CONTRACTOR ADDRESS <br /> (Ci ty,State,Zi p) (City,State,Zip) <br /> ®Setbacks 6 OA? <br /> fME` 41( i w <br /> PHONE <br /> PHONE Site Plan approval from q/' A <br /> b a 22d— L1 applicable township. l"�/�' <br /> E-\MAIL ADDRESS E-MAIL ADDRESS <br /> G` 6Ma S iii fl'4$. Corn La Floor plans to scale <br /> PROPERTY/LOCATION INieORMATION (http://accessdane.co.dane.wi.us/) Elevation of property /� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ei <br /> VIPARCEL C' p��n / ]]��� frontage drawn to scat <br /> NUMBER 031110102^1}1-X1000_6 )'C <br /> TOWNSHI SECTION:I7. !/74- <br /> in% A a id S W e 4. '/4'/4: Driveway permi /I� <br /> �1�� 7 ii (state,county,4:11P /, <br /> ADDRESS: j � <br /> /02ZZ /3 LOT ' k Mc\ 1e oA JT C3C62 4�Sanitary •- •••ts <br /> CSM: LOT S BDIVISION BLOCK/LOT (public,idIM <br /> PROPOSED PROJECT INFORMATION STAFF REVIE <br /> PROJECT DESCRIPTION: / <br /> S kt C �.c•.'Q (A, Oki pPr Zoning District Li —/ <br /> . laThis project is a new building or structure. /03 f <br /> XPermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ',�c� q PERMIT NUMBER: At Rural •l. <br /> EWER IEPTIC T'- )3^Zo1(!j r o 0341 7 (new <br /> HEIGHT IN FEET: r 1N NUMBER OF STORIES: (Not including basement) <br /> Z A i- s Wetland/Floodplain/ /� <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) /,� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT /+1�j j 1ST FLOOR: �j C ErosionControl permit _ <br /> 7 7 2 3 j ,, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 3,2ct0 2,..0/6 dYi� <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $3 �` �- and available options. I(/a <br /> (Please round to nearest dollar) <br /> 3 3 N./ <br /> v C) �t1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes KNo ❑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? E,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) Eves No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1lo <br /> 2 3 3 6 <br /> 9 { Li APPLICATION MUST BE SIGNED <br /> 545-112(4/08) J <br /> co /rc \ 5 (Contin n-B3ck <br /> 7z 9a cIk ' 4' 2_ C . 2_ <br />