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SUPPLEMENT to Web-App # <br /> ZONNG PEF�IIIIT APPIJCAl10N wwwool.rtyotdane.00m <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME \' <br /> 'r "\ ` `v\ ' a Zoning Status; CUP; <br /> OWNER ADDRESS\(Number,Street,C ate,Zip r e W1 csss ( Deed Restriction;CSM <br /> ��� '�` ) Variance(# ) <br /> HOME PHONE 1 CELL ONE E-MAIL ADDRESS <br /> �bg-90b`S tp3`1 „og-, otp-3V 4 S' ' ' vv, `^'`"`'`-.( Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> EN c._ LA-e,'3ov∎ \'v,\,N.o.c� Site Plan including location <br /> A T ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Sri o \7eVVAe- Dx 1-27,14° )o<-\,w-. CA- . Vie. 13 <br /> (City,State,Zip) (City,State,Zip) E Setbacks <br /> N\v, ova \/• 7S-1 1 �� 4 —V), Q \ AA SSS <br /> PHONE PHONE I <br /> 0 Site Plan approval from <br /> om <br /> k o�_ CSC. 1 LW-S �0,- - L\L L\ - L,v 1` \ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 2-A-NCa e-\z®c vvo,,\. (ay, ',`I W∎VMat.,,®c.„_o , <br /> c.ov Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usf) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: �evation of property <br /> ❑PARCEL 9CA 1 Ci Va y ` uS',, frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: 'S CTION: <br /> 1& (1 L GiVrI3 >L 1/4: 1/a'/4: Driveway permits <br /> ADDRESS. , '• , c (state,county,town) <br /> �‘ JGD ' �-1t2\ , Vu\ S�S Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1*,) (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: i O I t I_ _ <br /> (2 `OACt, 2'�2 I47 OID-'{ ❑ Zoning District <br /> . EThis 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 /> FIEVVER REPTIC -- C \ (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 5 ).--'-1--. i1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> EASEMENT: 1ST FLOOR: r--, ErosionControl permit <br /> I 1 fY + TOTAL SQUARE FO TAGE: j (slopes,disturbance, <br /> 2ND FLOOR:t il..)..1 3RD FLOOR: i i 1 Z� filling/access) <br /> �! L zI ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -1., -Ii. -+ ♦ 1 } and available options. <br /> (Please round to nearest dollar) I <br /> - 1.5 7• I° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave bla k if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o EDon't know <br /> 7. Is this to correct a violation? nYes 6No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />