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S co r —r— <br /> ZONING PERMIT APPLICATION www.county. . . -.- a , SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /` �/ <br /> peelz"-', l/loui LW Zoning Status; CUP; <br /> OWNS ADDRESS (Number,Street,Ci ,State,Zip) L Deed Restriction; CSM <br /> 21 v' ror) c/- ���yh Ai/ $3 %9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> "Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5 t-6 vrcr/ v/j.-i% 4,' - / w 624 iP 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic Igo <br /> /76 iiK070-7,4– -7-*".z- cielii if 1A-e Ad. <br /> (City,State,Zip) (City,State,Zip) lid Setbacks <br /> n` W '51 5-b Z /4/ 9/l 1 w/ <br /> PHONE � PHONE VSite Plan approval from <br /> pt9t'836-7 ..7L le O -2 7/ - 0 3(o D applicable township. <br /> E-MAIL ADDRESS / E-MAILADDRESS <br /> )5b vi 'Y: A"1 ��''ek/T�' fa Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: • ACREA p p y <br /> PARCEL ,/ frontage drawn to scale. <br /> ❑ NUMBER O*Ci'/OWI-317__ 7-G' /Q- / • g <br /> TOWNSHIP: SECTION: <br /> q 4t/ WA: Driveway permits <br /> Sze S�nys 3 /4: (state,county,town) <br /> RESS: / / �ti// (� <br /> 3°b [^ L �� ©�c S `.2.6 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIVLOT (public,private) Wier <br /> PROp6- 7-naUJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Nat �vti e ❑ Zoning District <br /> . This 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 /> 'SEWER/ Li SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 2 ❑ 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: 1ST FLOOR: ❑ ErosionControl permit <br /> 3200 � g ill ,, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> V " """/) yfilling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> r c2 �� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 11i�� and available options. <br /> (Please round to nearest dollar) -- -4. 4► —10. 7' - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 3/No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Li Yes L' No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? E-Yes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L/No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blanlyif none) <br /> 6. Is a location survey required? (see reverse) ❑Yes di No ❑Don't know <br /> 7. Is this to correct a violation? Li Yes dNo <br /> 2 b APPLICATION MUST BE SIGNED • <br /> S �� <br /> b 53 ` l� (Continue on Back) •-*545-112(4/08) <br />