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SUPPLEMENT to Web-App # <br /> ZONING PE NIT APPUCAI1ON vwwkoouitycida acom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ali <br /> /7�r'es A iY1t! ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Z4 Deed Restrcti0 ,CSM <br /> ‘0A7(0 Ahoa Art QeGt. C e ilr k( S3S76-- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 9 • 71 'S ❑Site Plan drat o scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 7-JAI 1-01,her,sinfrl A ei/ic r 6ag,taye A <br /> cir ie✓S ❑Site Plan�iincl ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/sE tyc <br /> v <br /> /-2 Q4 en epp,A;6e lam- .S7ly 41,-in ert,,d( 1)" <br /> (City,State,Zip) (City,State,Zip) ❑SetaC,1S <br /> Vevoli4 (.t l S3 S93 5h I?i tirie� t2: S3S90 V <br /> PHONE / PHONE ` p Site PI n •iyo - from <br /> oZ-35 1 /0 b € 2 3S. /6 (.4, applic t. .hip. <br /> E-MAIL ADDRESS / E-MAIL ADDRESS <br /> y) e 4vgega 412444, -` coo ❑ Floor plat\ to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation f r ert <br /> PARENT PARCEL NUMBER: CU RENT ZONING: ACREAGE: p y <br /> ❑PARCEL p5 C7�,RA 1,09.52, frontage d n to scale. <br /> NUMBER �9.5� , <br /> TOWNSHIP: SECTION: <br /> /,/. ❑ Drive F�e'/�'. <br /> �N 0� �4' ° °' (stated/co`�n ,t•wn) <br /> ADDRESS: <br /> G0.2?Go AtiI-OAline, C1 Ov`e9oil ❑ Sanit-t ,v <br /> GSM: LOT SUBDIVISION BLOCK/LOT <br /> c ;a✓eH oaks (publi,, tits-- <br /> PROPOSED PROJECT INFORMATION W <br /> �RMMATION STAFF RE IE <br /> PROJECT DESCRIPTION:2 5 0Z s' J e Ltd( �41 ❑ Zoning is ct <br /> . giThis 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 /> EPTIC (new/existing) <br /> HEIGHT IN FEET OF STORIES: (Not including basement) <br /> /!/C Oh ❑ 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 /> BASEMENT: 1ST FLOOR: r---, ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: (D filling/access) <br /> /(0 ❑ Revi o ; • O•ey <br /> ESTIMATED CONSTRUCTION COST: $ �7 and a ab - •• i• <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ .p s� 0 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes A o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? :Iles an o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes It o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave .'ank if none) <br /> 6. Is a location survey required? (see reverse) ∎%k es •No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes NNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />