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ZONING PERMIT APPLICATION www.cou ' • I , ., sin SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER O PROVIDE <br /> OWNER NAME i <br /> � 1,()a -f ; lllcrn ❑ Zonin <br /> 5 '_/ <br /> OWNER DRESS (Number,Street, , tate,Zip) Zoning Status;CUP; <br /> Deed Restriction;CSM <br /> c�• Li / ' l4 S Variance(# ) <br /> HOME HONE CELL PHONE E-MAIL ADDRESS <br /> j '47'3t/a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AG: T•'DRESS CONTRACTOR ADDRESS of wall/ <br /> (City,State, i. (City,State,Zip) 'Setbacks <br /> PHONE PHONE , <br /> applicable township. <br /> E-MA ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acccsso.:ee.co.dane.wi.us/) <br /> PARENT P U 5 L( UM ER: CURR. TZONING: ACREAGE: Elevation of property <br /> rty <br /> ❑ PARCEL at <br /> LOO7—1Q) yA — 1 1 3, -) rontage drawn to scale. <br /> NUMBER O /-t (J <br /> TOWNSHIP: c1 Q„ SECT!: <br /> C v da 1 a U / ¼: )L) 1/41/.: S w CLDa s <br /> ADDRESS: <br /> (state,county,town <br /> A co a S fie A.O. % )- off')4 . 40 (-e Li aaltaFy por,;tc..- <br /> CSM: LOT SUBDIVISION BLOC OA (public,private) <br /> PROPOSED PROJECT INFORMATION m �' <br /> PROJECT DESCRIPTIO : �' $ a. <br /> S1 -J �cx�8 � <br /> . 6 This project is a new building or struct► -. _ , <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> v.„,:,-„,:l� <br /> SANITARY SERVICE: PERMIT NUMBER: n °a <br /> ❑SEWER ❑SEPTIC -, . vE-a ' `, x ;*• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1:".-:' .' • .1 <br /> AREA TO NEAREST SQUARE FOOT: -, 3 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) L °' ; > <br /> BASEMENT: 1ST LOOR: T f ®, '-4, <br /> I q0 4, TOTAL SQUARE FOOTAGE: ,�, ` : .P � " � <br /> 2ND FLOOR: 3R FLOOR: -[/J �J1 tg. <br /> !L ( / O xF '_` -..0: 1,14...r.,,gyp- <br /> '� ss ''.e . Al*� <br /> ESTIMATED CONSTRUCTION COST: $ - :4�0, � <br /> (Please round to nearest dollar) "∎ —* "∎ "∎ $ 1, r!c- sTZ :_ <br /> L1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? �'t't'Slo ❑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? ❑DY"es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Fes �,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) ❑Yes ❑Noon't know <br /> ______,7. Is this to correct a violation? ❑Yes ESN <br /> ) Dp <br /> .--(.7 APPLICATION MUST BE SIGNED <br /> 545-112(4/09) <br /> rQ� (Continue on Back) —► —0. <br /> 1 5413 <br />