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7 ,) ° 3 C )1 <br /> ZONNG � CATION v wwcour tyofcane.00m SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N E ]�1 1 <br /> i1 4 4CC 11\let?.\ (1;bb5 <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number, treet,gity,State,Zip) <br /> 252 6,Ac — ICA( 1 30A P$�''ri e IA Deed Restriction; CSM <br /> / �3Spo Variance(# ) <br /> HOME PHONE Q CELL PHONE E-MAILADDRESS <br /> '41-a -Ki ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT OR ME <br /> Yet,�t 6)gJ/ <br /> eri ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS V of well/septic <br /> i1 29 Scenic �'e� R 6 <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> (k);/1646,, wr s3sgW <br /> PHONE PHONE ❑Site Plan approval from <br /> 66s)-Z - 7794/ applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> -y co ns f- <br /> A..14 co c t.+On 1 ryia ,tour ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCE NUUMBER' CURRENTZONING: ACREA ❑Elevation of property <br /> ❑NUMBER 012 0911-212-4241-(4 R' i �Y frontage drawn to scale. <br /> SECTION: <br /> ri5 'o '/4: ,/4/4: ❑Driveway permits <br /> (state, county,town) <br /> ADDRESS: ha do `� if r �q <br /> 2 'Z,1 5h4Aow " A� � 501 Pat te-j tOL �3J/° ❑Sanitary permits <br /> CSM: LOT SUBDIVISION • BLOCK/LOT <br /> • (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: J. <br /> �ecK Rpt'n lac een en.-1 ❑ Zoning District <br /> ❑This 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 /> EWER REPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ 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 1STFL0 <br /> ❑ ErosionControl permit <br /> ,l TOTAL SQUARE FOOTAGE: y (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> v <br /> 31-lc ❑ Review Location Survey 77 5 ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ `�1 and available options. <br /> (Please round to nearest dollar) , <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 ❑No ©Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? GcYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Ilo <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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? [Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />