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ZOMNG APPUCA11CN con SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> OWNS 11ST/C-K L c R Ing Status; CUP; <br /> Z41 <br /> ADDR SS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2? 3S !—.4th/I4 t a. Z.gNt WI 5 IS�9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> S i 1 aIt3 Sit n drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGEN NAME CONTRACTOR NAME //��� <br /> M Ma�i?SON �� 1-ptfe4/4 414 G / Deo- ❑Site Plan including location <br /> A ENT ADDRESS N RACTOR ADDRESS of well/septic <br /> /20 `f �h/T b-i21zi*Z /SE k. s-260, LiNNFitM Alt. <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> V 4 i G✓!- SSg 3 SUN PRgti4.(e Wt‘. 535 le, <br /> PHONE PHONE r ❑Site I proval from <br /> 3S' /$co € -Z 3S '/&co, E, a ' ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Flo ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT Z9 NING: ACREAGE: EI on of property <br /> ❑Nu <br /> NUMBER <br /> n3 OTS G3 °/`�N 9 r-) gq-/e ), 3 frontage drawn to scale. <br /> TOWNSHIP: S CTION <br /> 414 F ,/: %IA: ae Ive pe its <br /> ADDRESS: (state,c ty,town) <br /> --23S Lv, .---, ❑ <br /> CSM SUBDIVISION BLOCK/LOT <br /> 02000 (p - C, •rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2 'X 2 q b E• .4.61-1 e ) 6A 14 E nir>!q District <br /> . El This project is a new building or structure. <br /> rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER - Si Rur- a•• <br /> DEWER ITEPTIC (n- • • <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0 1 II Wei_••r- •-.plain/ <br /> Shore ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> • Erosl• • ontro permit <br /> BASEMENT: 1ST FLOG �7 4, TOTAL SQUARE FOOTAGE: 4, slopes,6-- ' Lance, <br /> _q 2ND FLOOR: 3RD FLOOR: f <br /> fi '•• .« ess) <br /> / S?GO Review urvey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ `,� and - _I ab� •• IOr1S. <br /> (Please round to nearest dollar) $ �/ <br /> � G <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IJYes 1lo ❑Don t know <br /> 2. Is there a wetland or floodplain on or near the property? fYes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Et <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 o ODon't know <br /> 7. Is this to correct a violation? ❑Yeslo <br /> APPLICATION MUST BE SIGNED <br /> 545- (4/08) (Continue on Back) <br />