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44--, (2 tER <br /> ZONING PERMIT APPLICATION www.countyofda e.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> DEL Te)/r/, .T c,A/C <,4 R LE-4/ <br /> ❑'Zoning Status; C <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restr n; CSM <br /> ,2 7- , ,/,2L T, S',v v?, /'e'C, 4.217 3-5.590 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE ' E-MAIL ADDRESS <br /> lva 8 2k7. 6 `--e N.4- ❑Site Plan draw to ale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di nsions <br /> AGENT NAME CONTRACTOR NAME <br /> -/Ri IJRepgERG- Etv/t/kE- t,•)-�a.Cs ❑Site Pla in ng location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel I/s is <br /> 6241 7 A4-�✓E-ci-L.v <br /> (City,State,Zip) (City,State,Zip) ❑Sett;peks <br /> J_taRE3r w.r -s-3s-3 Z <br /> PHONE PHONE ' ❑Site Pla A alp./al from <br /> 6E Z./3 .9,2V applica% _t., •hi.. <br /> E-MAILADDRESS E-MAILADDRESS <br /> erwi�d‘P - Q Lioo.Cro ryr ❑ Floor pla s o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation cpf pr perty <br /> ❑PARCEL frontage d n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> •%?(srve 1/. -/4+/4: ❑ Drivewa .e <br /> ADDRESS: (state,c. ' to,,wn) <br /> 275� �ti L gT SvA/ LK,A� /E—� Gvt' .5'3s--ye ❑Sanitary pe is <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 76 /?olfRt�rice 3� (publi vate) <br /> PROPOSED PROJECT INFORMATION STAF REVIEW <br /> PROJECT DESCRIPTION: ei(ff-rk9 <br /> /ADD/A/6, f!- 3 . e ..1'>i per-a, c'-,. )` de c4 ;/eca.,416, ❑ Zoni is 'ct <br /> . [This project is a new building or structure. ❑ Pemmi Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Ad <br /> EWER [)EPTIC (new/e g) <br /> HEIGHT IN FEET: 1 NUMBER OF STORIES: (Not including basement) <br /> C� / ❑ Wetland/Fl plain/ <br /> Shorelan (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: 1--, ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes di ance, <br /> filling/ad' <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2 Z S ❑ Review Lo on Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ —0. \ and av it a options. <br /> (Please round to nearest dollar) $ //`� 'T- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Dlo ['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? ❑Yes 3Jo <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 Io ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑I o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -i <br /> 545-112(4/08) <br />