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ZONING PERMIT APPLICATION www.countyofdahe.CO SUPPLEMENT to web-App <br /> PROPERTY OWNER INFORMATION CUSTOMER O PROVIDE <br /> O ER NNAAM•,EE }� <br /> b ` T V)+Z — ❑Zo ing tatus; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 424,2— 6i <br /> -fir Dee estriction; CSM <br /> 219 bergerlticIAk BLvO. 0E(vo.J W 1 5 397:1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ", i•309. 193E 6A-4A-L' Rtc.kYkuTzk &GM mi..GGM ❑Site Plan d aw o scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include Imensions <br /> AGENT NAME CONTRACTOR NAME <br /> MIS `5precANau-- 5P2.er-H-g ., Cu5?Uw. Rim /7 ❑Site PI n in uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel I/s tic <br /> 75c likasy VI eta' PI' 79/4 yitiP( - 4U a� <br /> (City,State,Zip) (City,State,Zip) ❑SetbVIC <br /> vED.U.A- we 53c/3 Uozcwii- Lo '93 99 3 <br /> PHONE PHONE ❑ Site Plan m <br /> (o[,1g-22 .-to 2s &d8_22S- 1'9 214 applicable townsh . <br /> E-MAIL ADDRESS E-MAIL ADDRESS k ' 1 <br /> #=72-z.fi-ti2 @ -/1;A-i/.Cp.mil M *PR E2C� 6M►OI t, CO w. ❑ Floor plans tole <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUR fMl ACREAGE: ❑ Elevation of r erty <br /> ❑NARCEL VI/ f rontage dra to scale. <br /> NUMBER •SOU•l��l 6/020. U /'rte. <br /> TOWNSHIP: SECTION: <br /> 2044 Prlu 7 1/4: /'/: El Dri e 144^ <br /> (St• i• <br /> ADDRE 1 S: <br /> t ©5o <br /> L E c. 4- R• ❑Sanita er ' s ," <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, p v e) <br /> It 34 2— <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Xe <br /> SRI2– 35a0-7,,, U Zoning s t <br /> . This project is a new building or structure. <br /> �p�y��.-e 4i ❑ Perm to se? <br /> gThis project Is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R,��r ar)Address <br /> FIEWER PEPTIC 13 -201 7-Do/ 2 Z • �� /existing) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> -0'A 3, 5 2_ ❑ Wetland/ loci lain/ <br /> Shorela ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unf'nished area,attached gara.- .,d .love grade decks or porches) <br /> BASEMENT 1a. e 1ST FLOG/ <br /> � ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: + (slopes, disturbance, <br /> filling/Cs)c�/s) <br /> 2ND FLOOR. ie II SR9-Fteeft: /"�,f ' /_ j✓ <br /> `p vr/1��!_- Review Loc io Survey _ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q� /�,�� r— and avai s. <br /> (Please round to nearest dollar) $•3!Q S,C 00, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ❑No Don't know <br /> r <br /> 2. Is there a wetland or floodplain on or near the property? Efres tip Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 0Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 0No <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) Elves ❑No Don't know <br /> 7. Is this to correct a violation? Eves IZ1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />