Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.00untyohdaml.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Su Z4 /v iv--- j_'�r DA14,2 ❑Zoning Status;CUP; <br /> OWNER ADDRESS(Number,emit OM BMW as <br /> Deed Restriction;CSM <br /> 3i/ 1/ e P N1 A/ "V) t Jf 57c-s-d Variance(# ) <br /> HOME PHONE CE L P(( 4' <br /> PHONE _ ,, .. <br /> / -- y-� 60 -✓0f-/ I% El Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0s Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ofweWseptic <br /> (C*X ar4 aP) gab am%2/P) El Setbacks <br /> PHONE PHONE ❑Site Plan approval from applicable <br /> E.IMAILADD S E.M MLADDRESS Floor plans to scale <br /> PROPERTY.LOCATION INFORMATION (http: accessdane.co.dane.wi.us ) D �propy <br /> PARENT PARCEL NUMEErt CURRENT ACREAGE <br /> 66/0 o r Z 0S9O� '3 / 3 , S 3 frortage drawn to scale. <br /> 1/41/4: 0 Driveway permits <br /> (stale,county.town) <br /> rowr�srllP: <br /> ADORES& <br /> -3 442 y 0 g / ') /t4c1-4i21 A-A n w 53s D sar�ryperTR� <br /> cat i 1 2_7 If LOT SUBDIVISION (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF Ai <br /> PROJECTOEe(EPTIOrt <br /> Deck Gt"d n}-v,/rxrf r*i ps ❑ Zoning Distrid <br /> . DThis project is a new building or structure. ❑ Permitted Use? <br /> 13This project is an addltlo&aisradon to an emoting bulking or structure. <br /> SANITARY SERVICE iievartaumeErt ❑ Rural Address <br /> DMIER RIMPTIC (fig) <br /> HBGHT N FIB NUMBER OF STORE& (Not Including bo..r,q <br /> M'' X ld - Shoreland (attachment) <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑:ErosionCOntro perTt t <br /> 9ASBNEN1` +sTROOR 56 sq_ j TOTAL SQUARE j (slopes,chsturbance, <br /> firing/access) <br /> 2ND FLOOR 3RD FLOOR: <br /> 5 oO 541- F T ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST and(P to nearest dollar) ♦ -♦ -♦ 'r $ /O/ cycle , C O e ifabie <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes 04o ['Don't know <br /> 2. Is there a wetland orfloodpiain on or near the property? Ekes I • on t know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes <br /> 4. Has there been a zoning permit issued for this property in the pest 5 years? Dyes jlo <br /> 5. is this project associated with a rezone/CUP/variance(petition/appeal# 3/37-) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dyes j ' Don't know <br /> 7. Is this to correct a violation? Des <br /> APPUCA11ON MUST BE SIGNED <br /> (Continue on Sack) -■ -► -o► <br /> 546412(4iO5) <br />