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• <br /> . ZONING PERMIT APPLICATION wwwww.countyofdarm.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME J�� r <br /> Ie n (N eh A 0 r T ❑ Zoning Status;CUP; <br /> OWNER ADDR (Number,Street,City State,Zip) t Deed Restriction;CSM <br /> II Go I e a.5 a. 11 t ii �t /Qoi, S fe.05J. 4 re/l i G(w, 5-358 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> 6o g-$l 3.343/ 60$ -013 S'- ds S a,w en dorPQ 6o,h„mereP,642fe."1)'.6 5 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAP& <br /> S e / F Se/ t- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> . PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ❑ Elevation of property <br /> ❑ P RC ER os'l` 1/3- i56"6-- S" ct4 z 5 8 6,,/ 4e//7 frontage drawn to scale. <br /> TOWNSHIP: y SECTION: <br /> on ft I" j/ y: V1O '/%a:6 W ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> I/(ye P/el 6 an t M.'/! 40e ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Sao© C 5 2.3/2,0 3-'/ / (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: n e t0.C 71 e /' <br /> (e G Q ❑ 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 ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not Ong basement) <br /> c r So f ,'t / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> T <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosiotlCOntroi permit <br /> BASEMENT: 1ST FLOOR: <br /> g x 2 0 r 4, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 81 o <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options.-o. -I. -I. , <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? ❑Yes CiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 3 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? (AYes ❑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) ❑Yes arNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ielNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 545112(41n8) <br />