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o I ter )lol <br /> ZONING PERMIT APPLICATION Y <br /> nt ofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> LImpAvog, JyA/ Rog oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 85L1 OpES rzr (_-fisrl,E , VQ20NA (N( �35 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL-M ILADDR SS <br /> 64:-i - '9,li 9 ,4-51 -no ►. S ' awl, A' st Rolfe—Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> _1111" t _,11., W. gi 11 ,i [ ,Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1 , _ .11.'. a <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE P ONE —0 <br /> 40 Sq ❑Site P proval from <br /> 6 -asp -10/50 ap • b township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Am' .. @ ` , . _9 'Ca oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El ation of property <br /> PARENT CURRE TZONING: ACREAGE: <br /> I=1 <br /> PARCEL //�� //-- onta a drawn to scale. <br /> NUMBER r •Pe •i r�f -4M—i4 /0.1(L g <br /> TOWNSHIP: SECTION: / <br /> 14OAIT7lOSE 33 ya: N e '/a'/a: tJ„! ❑Drive „�mits (�]� . <br /> v AD�R (sta -,court )Owr1T` \y^\\\ <br /> L C / , i • •'87 Sanita <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ ry y <br /> (public • <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,,-�,, ff <br /> `JIN Le FtLy P.FIWEksj cL /O1.7T�Ul( 4kJ(T I31/Z - <br /> District <br /> . 4I This project is a new building or structure. / itted'Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER f PTIC 13 - z(-. -003z0 fisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / /Z5 I :._ loodplain/ <br /> - orel-nd ,,L,!-c ,s-nt) <br /> AREA TO NEAREST SQUARE FOOT: ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` rosionControl permit <br /> BASEMENT: 1ST FLOOR <br /> Z L ,d �^ I FLOOR: <br /> l 5 ` ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> (f( 11 [J "I filling/access) s <br /> 2ND FLOOR: 3RD FLOOR: d <br /> 69 /O k 6-6 y view Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) •p‘(Rai 280 ilgO e <br /> i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑1'es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? E]Yes ❑No <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 ONo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />