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ZONING PERMIT APPLICATION www.caunryofdane.cotil EU LEMENT#o�IHeb Ap
<br /> p ROPERrt-OWNER:INFORMATIONC= t - x a CUSTOMER TO PROVIDE
<br /> OWNER NAAMME'�' �f
<br /> / `�I (2 nei>l/ ❑Zoning Status; CUP; •
<br /> OWNER ADDRESS (Number,Street,City,State,Zp)
<br /> Deed Restriction; CSM
<br /> 6-7 67 Pe7.e. er C S'&4 loci-.e! e- 0" Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDD ESS •
<br /> • 6 0 3 5 7 6 l3S ,do`,I. ©ne://@ ' 4•1 e '''G, ❑Site Plan drawn to scale
<br /> . AGENT-1N'FORMATION_„ tCONTRAC OR'INFORMATION ' ,•,_4r " and includes dimensions
<br /> 'AGENT NAME CONTRACTOR NAM J
<br /> Soh. �an/a • Z 4G: GS�i Ae7p 4 ❑Site Plan including location
<br /> AGENT ADDRESS CO CT RADDRESS Li ofwell/septic
<br /> - 7602_ R v 15,'Gde /G1 .
<br /> (City,Stale,Zp) (City,State,Zp) ❑Setbacks
<br /> ve7 - 5393
<br /> PHONE PHONE ❑Site Plan approval from
<br /> 60= 27e7- 7i6 -applicable township.
<br /> E-MAIL ADDRESS p E-MAILADDRESS
<br /> Z-0 06'A '' le' C C 014/ ❑Floor plans to scale
<br /> Fa�w 3
<br /> PROPERTY/L'OCATION INFORMATION http Uaccessdane.co dane wi:us� -;� Elevation of property
<br /> PARENT PARCEL NUMBER CURRENT ZONING: : ACREAGE
<br /> IIIPARCEL frontage drawn to scale. .
<br /> NUMBER .
<br /> TOWNSHIP: SECTION:
<br /> 14.: /,/4. El Driveway permits
<br /> •ADDRESS: (state,county,town)
<br /> . ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION = ` - '-"
<br /> v 5.. �. ;S.TI�AF�r.' FtE_�[IEVII� . r�-
<br /> PROJECT DESCRIPTION: 4,YY?,5.5 :-Z-5.a :-" e.1.;2 : ,1 �'
<br /> y.: e«C
<br /> E2 TZoning=Distric l,, ,zV.,. , _
<br /> . ss�''�.�?>.�_%3r� Vii;���T„-,>s.�,.�r
<br /> ❑This project is a new building or structure. EIS"'�. iV �•
<br /> 1-Ptmltfed�Use? �f.-
<br /> This project is an addition/alteration to an.existing building or structure: :•"-e- t
<br /> SANITARY SERVICE PERMIT NUMBER 'U;Trral,Address- �4: ,
<br /> EWER �EPTIC Cnew-eXISt!(19) ^f't ' y
<br /> HEIGHT IN FEET *.w: . �� `"` 'Y'' r.j`
<br /> NUMBER OF STORIES: (Not including basement) `< *x:;Fri
<br /> Shoreland Pa c-h-ment_?;
<br /> AREA TO NEAREST SQUARE FOOT �"��`^,,�_;�,...�:�- �.,�.�;,,=r •��:•>F,
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) =�: - ,e.,;:�• 65r
<br /> BASEMENT 1ST FLOOR l2_ ---Eroslo Co tsp_permit :;
<br /> 'slopes--.`ancante=1 t
<br /> TOTAL SQUARE FOOTAGE: ,l.. ,_�—. ,� , r:��;:, '
<br /> 2ND FLOOR 3RD FLOOR: -- yY; `J"
<br /> 3r ,.
<br /> '.:*' •w-Lo attontSurrve`
<br /> ESTIMATED CONSTRUCTION COST: i' , r, `' sya- Vx- -'-
<br /> ♦ ,..� ,♦ ...� .♦ ,..� ;�t:,.=an_d:a alabfl'�t.I,�ons,�.y.�.�=
<br /> (Please round to nearest dollar) 1 r)00. ..
<br /> •
<br /> • 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Peso ❑Don't know
<br /> 2. Is there a wetland or flood lain on or near the property? • es -' o Don't know
<br /> P P P � ❑Y ►� ❑
<br /> 3. Have you talked with the township about your project and are they in agreement? SVes . o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - nYes El o
<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 • ❑No riLon't know
<br /> 7. Is this to correct a violation?- ❑Yes !t o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) .—► —► —0
<br /> 545-112(4/08) - . -
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