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ZONING PERIVIT w PP ,CATIOisl tco n SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ' lc-h-- K 1`e oning Status; CUP; <br /> 0 E�RZADDRESS Number,St pCity,State,Zip) Deed Restriction;CSM <br /> HOME PHONE � �CELL PHONE `aAk ADDRESS �� 5�5 Variance(# ) <br /> rii".35-0390 t 3 k - • " " , : . a G ,Site-Pt'an drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION `�'and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ma- k<1 e1 Ian including location <br /> AGENT ADDRESS CONTRACTOAA D SS of well/septic <br /> //may <br /> State,Zip) (City,State,Zip) S asks <br /> PHONE PHONE I:I Sit E� rOVBI from <br /> appli ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation of property <br /> PARCEL NUMBER 054/06901-2,54-32.6C O •,(� {+ /0 1,./ frontage drawn to scale. <br /> TO SHIP: SECTION: <br /> ` � (jcl '/<: '/a'/a: 0 Driveway permits <br /> ADORES : (state county,town) <br /> cSM: LOT SUBDIVISION BLOCK/LOT �r.�s arntary • rmits <br /> Q f�,- ,• <br /> og (public ' <br /> __ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIO : '^ <br /> • Ow \a k 1 n ots2, t � t( oning District <br /> . 05 This project is a new building or structure. FLUE6iitted Use? <br /> •This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Address <br /> SEPTIC /V 1 — ( •EWER > � L)/� 1 �� <br /> HEIGH T IN FEET: e27, k � NUMBER OF STORIES: (Not including basement) —�►A Ij� r"oodplain/ "C (^ <br /> g • - and (attachment) °C <br /> AREA TO NEA JESTSQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) fJ trOS10nCOntr0)permit �[ ^„I <br /> BASEMENT: 1ST FLOOR. 2. t v C <br /> /O4/6I 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, y <br /> �)�( fill' • access) O o <br /> 2ND FLOOR:9is 3RD FLOOR:(p,Q.,Q4•�,E C7 r`' oI <br /> ``f� <br /> • , J �'7�1/ R -eview Location Survey l�I <br /> ESTIMATED CONSTRUCTION COST: $ qW pU and available option <br /> (Please round to nearest dollar) '* ♦ ♦ ♦ '•r '• i <br /> n <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑lies �No fDon't know � <br /> 2. Is there a wetland or floodplain on or near the property? es 8No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ,JNo <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) ❑1'es No Don't know <br /> 7. Is this to correct a violation? Wes ,lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />