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�+ <br /> ZONING PERMIT APPLICATION -ci ".ane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> £ p�4 es �I Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stet,Zip) r�peed Restriction; CSM <br /> -turn Eb€uY �L vc 5GeAD1 DI L Variance(# ) <br /> HOME J ' Li r '` thccb• L' I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION /and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> OJ S7 ( CJ rr 1}v <br /> tiV11-S Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4ot N. CVtt1Xt j Av kik,< <br /> (City,State,Zip) (City,State,Zip) ®Setbacks \/ <br /> V\) w I s&sa-� jT <br /> PHONE PHONE Site Plan approval from <br /> LOQ —B D 4 �C b applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDR S^!'^ <br /> ' _, l.� `d COJJACUat.COV,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCE NUMBER: /�2 CURRENT ZONING: ACREAGE: P P rty <br /> ❑NUMBER Da01o1oS-13'00- l4 L 0 frontage drawn to scale. <br /> TOWNSHIP: SECTIP c 1^ I <br /> A � P IA. q& '/a'/a: SV A/ g Driveway permits <br /> ADDRESS: (state,county,town <br /> ..rte' �i <br /> =. � I" I' VK Sanitary permits <br /> CSM: LOT SUBDNISION =LOOT <br /> 14 •WAsomfr 06 . q- (public,private) <br /> ) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT S .DESCRIPTION:�Lw ►Wr Y 1"l,_ <br /> SS rF/.QC� ❑ Zoning District <br /> . I?his 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 /> HEIGHT IN FEET: VtEPTIC \3- W ' -000 i l (new/existing) <br /> �� j'� NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> L� Z Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 1�� h 2 ��((//�/ 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: . ,`//� 3RD FLOOR: filling/access) <br /> �tS0 -161 0 S ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q �7�n, ^'� and available options. <br /> (Please round to nearest dollar) $ ( ti - . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es Ni4o <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) QYes LIVo (don't know <br /> 7. Is this to correct a violation? QYeso <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(4/08) <br />