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ZONING PERMIT APPLICATION www.countyordane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE•OWNER NAME I • <br /> VI.Qil c L ct r1 11-cwT1, ) Li_.L 0 Zoning Status;CUP; <br /> OWNER S(Number, S to.E t Deed Restriction;CSM <br /> b0i T 1 d-f 1 IF4t.,I. tiili,c. 5 1t variance(it ) <br /> H9. CELL PHONE E-MAIL ADDRESS <br /> ' �' Jc� 0 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> • <br /> 540 A 5 I.' ) V t 0 Site Plan including location _ <br /> AGENT ADDRESS CONTRACTOR ADDRESS ofwelUseptiC <br /> (coy.one,ZP) iii.state.ZIP) • 0 Setbacks <br /> PHONE PHONE • • 0 Site Plan approval from <br /> . applicable township: <br /> E-MAILADDRESS E.MAILADDRESS <br /> 0 Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http:llaccessdane.co.dane.wi.usl) U Elevation of property <br /> AR4 fr PARCEL NUMBER: CURRENTZONING: ACREAGE: drawn to Scale. <br /> NUMBER . .._._ �- <br /> e i pernYtS TOWNSHIP: SECTION: <br /> —' s <br /> (slate,county,town) <br /> ADDRESS: �/11 <br /> CSM LOT , • 4 �G'�LZ C iI 0 Sa,illtaryPenults <br /> = oN BLOCK/LOT (publ'c,p <br /> AUcc..1-10 llo J _ <br /> PROPOSED PROJECT INFORMATION i <br /> PROJECTDESCi1PTIONd: ' rp,. _ Ltd Co ilSi-rvt c.:1-,.6-, 1 <br /> • . 12ffhis project is a new budding or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> I —_EEBM[T.NUMBER • _ - - <br /> sawEIR ❑sonic 13— ao t '7 —0 In 3 g <br /> HEIGHT IN FEET i • NUMBER OF STORIES: Not inducting basemaW <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unilnished area,attached garages and above grade decks or porches) <br /> .BASEMENT: IST FLOOR. <br /> I V �}(0( a 1 TOTAL SQUARE FOOTAGE 4..2NDFL••' t 3RD FLOOR: <br /> c� ^��� /`3 <br /> l 3 e C . STN f — <br /> ESTIMATED CONSTRUCTION COST -► -4- -I. -I► -I' -I~ <br /> (Please rtwnd to nearest dollar) $ 49a 0 . _ _ . _ . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0.Yes No •D Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1No 0 Don't know <br /> 3..Have you talked with the township about your project and are they in agreement? dyes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? MrYes 0 No <br /> 5. Is this project associated•wtth a rezone/CUP/variance(petition/appeal# . ) (l ere blank if none) <br /> 6. is a location survey required? (see reverse) 'es 01to ❑Don't know <br /> 7. Is this to correct a violation? .. ❑Yes ( No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) --I• -i -►' <br /> easttx(om) * 1/G 7, Q. 1 <br />