Laserfiche WebLink
ZONING PEFVVIT APPUCA110N WM couriyamane.00m SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> °NNE SA NGNEL I:Koning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / Deed Restriction; CSM <br /> .3`14S-Z /J - I R . 111A‘, /S01.11 WI S37/? Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> lElite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C NTRACTOR NAME <br /> To i LAMAitR SoN ANTE, 1 GqN 4,1Rg4t AL.. $ Eite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /204 E-NT&-MI5E .1* S71, LimseRb DR . <br /> (City,State,Zip) (City,State,Zi ) Ers-etbacks <br /> VE rQ o• A WI s ss-q 3 SL j r.[ PRA(RA,PO S'3 S"/0 <br /> PHONE PHONE ite Plan approval from/1/4/.4. <br /> 2 3S• l 8 (o& 2.1S • /8 $ app icable township. �t <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> T e4 • • E4Jr ,, J„_,K - Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 18Vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P Pe y <br /> 0 PARCEL NUMBER v$1C�-a 3y -g8yo 7 R -1 -4 frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> bU g ACE a. .- ' : Se '%'/: SE taewaypermits ,(/�! <br /> ADDRESS: � (state, county,town) <br /> 3Y-S.2. Rb. 11AAt So14 VYI s3 ?)E' anitary permits fU f c <br /> CSM: LOT SUBDIVISI'1 BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: e <br /> t‘ii )C .q b t 'TA c N&4 6.4RA 6 E OrZZoning District <br /> OThis project is a new building or structure. e! Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 13‘al ,•• - <br /> IEWER DEPTIC (new/: <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> �' 'ON El 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) rosionControl permit J <br /> BASEMENT: 1ST FLOOR: J <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> .33 ❑ Revie Locatio Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ /SI aQ and a -Table 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? nYes Elo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres L o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le.ve blank if none) <br /> 6. Is a location survey required? (see reverse) gjk es o QDon't know <br /> 7. Is this to correct a violation? Dies Vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112 l4m81 <br />