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ZONING PEWIT APPUCA11ON vywacountridanacom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ain arke)A Het' 'j ( Pao 4") Wing Status;CUP; <br /> OWNER ADDRESS(Number,Street,City,State,Zp) <br /> g t 23 O 1 d 14)dlo,..)4 y -3-& II"7 1,/,,,,), kJ/ 5 357 �� Restriction;CSM <br /> Variance ) <br /> HOME PHONE CELL PHONE -E-MAIL ADDRESS <br /> Q M Aa • P Aotma:I. Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes'dimensions <br /> AGENT AME CONTRACTOR NAME <br /> Jc5 5G Ce-h ,/r/ e." 31-3 CoAS-L.)/7in S. n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS.' of'well/s is <br /> 5 'ivtL .1 5 4'6r,-fpitClor 135.0 Cc,',;ry RI -3-6 <br /> (City,State,Zip) (City,State,Zip) C <br /> ri-r.. ilopG4, kJ ) 53511 . <br /> PHONE PHONE ite 'S <br /> proval from <br /> 601(- 215-32 00 app. bl ownshi ,3 <br /> E-MAI L ADDRESS E-MAIL ADDRESS <br /> 7I-3C6n (1/tin Z/!a-m4;/•c,,,n plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elev n of property <br /> PARENT PARCEL NUMBER; CU RRENT ZONI NG: ACREAGE: <br /> ❑NUMBER O /oco�a61`'To'o ' p��— / �31 z _, 2 fron .drawn to scale. <br /> TOWNSHIP: SECTION: ❑Dri permits <br /> A[7RE /5e "/: '/'/b: (stat ,county,town) <br /> ADDRESS: <br /> gi/13 (Da /10 k.-'-Y 7l� fie?7.- 1L it) l ❑Sa 'ta permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu private) <br /> PROPOSED PROJECT INFORMATION SWF REVIEW <br /> PROJECT DESCRIPTION: <br /> R�//a c..e. Scz.l . -t add l a.nd ii,, /S`t-,r I ortittg E tttd <br /> This project is a new building or structure. rraittad U <br /> 2C This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 ���Mdress <br /> EWER EPTIC . , i <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> `�' .etianc ioOdpl(a nt � , . <br /> Stu:in tan l (attachment) <br /> S;'"� <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside-dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST F OR: 9 e permit <br /> I ij TOTAL SQUARE FOOTAGE: ,.,....0.,..,.,;..-4, urtanCe, <br /> 2ND FLOOR. 3RD FLOOR: - )--% <br /> Rama( , tion=Surrey <br /> ESTIMATED CONSTRUCTION COST: j e tl,._.options <br /> Please round to nearest dollar) !0/ De, <br /> , , 111 <br /> 1. The pond is within 300 feet of a stream or 10fTQ feet from a and or lake'? .........-. ❑Yes ❑hfa ❑Darr'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<azoning 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) ❑lies ENO ❑Don't know <br /> 7. is this to correct a violation? ❑Yes ON <br /> APPLICATION MUST BE SIGNED <br /> 545-1 12 t ) (Continue Boa Back) -♦ —+ —► <br />