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7 SUPPLEMENT to Web-App S <br /> ZONING PERMIT APPLICATION www.coun yofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ,,j�E,z. S P/EGA E c_- ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> / Z Z Z f//C7flwy9`7 /� O C7or/, kUl. '� 3S"�-5 Variance(# f HOME PHONE CELL PHONE E-MAIL ADDRESS s 7 / <br /> 6,6_57.-5k:0-9- ❑ Site Pl n1U�lw io� 111 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and rock dimensions <br /> AGENT NAME CONTRACTOR NAME V <br /> / /Zti.//T SP,giE L_. ❑ Site PI in 'n ocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel e <br /> will /,/ri..(_ /ze,;44 <br /> (City,State,Zip) (City,State,Zip) ❑Sec <br /> O, EG•Or,-/, Atli. S 3 S?-\ <br /> PHONE PHONE El Site Plan .pprga 1 from <br /> (a)0- 5-2- —1 U89. applicao- .w «A,, <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Sra/EC7EL Z B /40L•e:0vti ❑ Floor plan t scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL MBER: CUR ENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑PARCEL et l O 07 d... qC(C ,R C frontage drawn to scale. <br /> NUMBER (p <br /> TOWNSHIP: SECTION: <br /> KvcimiuS ❑ Drive .y a-, its <br /> J - 1/4: 1/41/<: ($tat:, • , .1i : n) <br /> ADDRESS: <br /> CSM: r��q LOT V� I W SUBDIVISION ILk BLOCK/LOT ❑Sani its <br /> 1 (pu Ic, va e) <br /> PROPOSED PROJECT INFORMATION STIFF/REVIEW <br /> PROJECT DESCRIPTION: '1 7] ' <br /> 3 . l� ❑ Zoning istri <br /> L <br /> . <br /> This project is a new building or structure. ❑ Permitt Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A.: 'SS <br /> EWER [EPTIC (new/e isti,g) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Wetland/Fk oi.lain/ <br /> Shorelaalhic7�►( 1:4 hment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gar es and above grade decks or porches)4 ErosionC of permit <br /> BASEMENT 1ST FLOOR: SIo I':, •.nce, <br /> TOTAL SQUARE FOOTAGE: 1 <br /> 2ND FLOOR: 3RD FLOOR: fillinl/a es s) <br /> ❑ Revie o a rvey <br /> ESTIMATED CONSTRUCTION COST: Q� and a4il I opt ons. <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'? ❑Yes 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# ) (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 /> (Continue on Back) <br /> 545-112(4/08) <br />