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ZONING PEFVVIT APPLICATION N Kco ' SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME } <br /> .SC.2# C`j&M I d ❑Zoning Status; CUP; <br /> OWNER ADDRE S (Number,Street,City, a e,Zip) / /� Deed Restriction; CSM <br /> 73 3 Noy c/44/ <br /> �i�C�L E-MAIL �� V v , ���/ Variance(# ) <br /> 2'i •22t7 039'3 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGEN AM CONTRACTOR NAME <br /> Z-4ii 6 er sc// 4 wtrp'(L!i' 4eiidi ❑Site Plan including location <br /> AGENT AtDDDRESSS ,COONTRAC ORR ADDRE S g of well/septic <br /> zo ZipL"iifee kvi e Det (J 7&ZILi r1'eNt1Gt ❑Setbacks <br /> iSta c�• W/. S;S 13 S pa pr��t1rt r'C, Wi: s3S-q 0 <br /> P ONE _ Q PHONE ❑Site Plan approval from <br /> .Z.3 S ' /8&€ 23 5• / iti(.0 S applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> o,, !►NltaC 1 a;/ , , ,. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El of property <br /> PARENT PARCEL NUMBER: '/ CURRENT ZONING: ACREAGE: p p y <br /> ❑NUMBER 177ll0(oi( 71(�s-3 R 2 , S�� frontage drawn to scale. <br /> TOWNSHIP: SECT19N: _ _ <br /> �' V e V 'A: SJ t ' %: 5 t ❑Driveway permits <br /> ADDRESS y"e� 6ioltD (state,county,town) <br /> 2 9 3 3 A/ohd1 I)/ Cyr 4446Db1 W/- s37/5 El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /OS (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (p f x a 6 ' De t� 6/ 640,gf El Zoning District <br /> ElThis project is a new building or structure. J <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> DEVVER [)EPTIC (new/existing) <br /> HEIGHT IN FEET: / NUMBER F STORIES: (Not including basement) <br /> /4/ UPPe ❑ Wetland/Floodplain/ <br /> Shoreland (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: <br /> ❑ ErosionControl permit <br /> / j TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> (a'? ' <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 2 O( 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes RNo <br /> No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# I c)9 L ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes RN0 ❑Don't know <br /> ❑7. Is this to correct a violation? Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />