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• ! tT7, 8f f l p p <br /> SUPPLEMENT to Web•A # <br /> ZONING PERMIT N w ow. toom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> .Sic' 4-E Ye kt *Ii J4a/JP/G ❑Zone . , CUP; <br /> OYYNER ADDRESS(Number, City,Stale,Zip) <br /> Deed -P.", ;CSM <br /> � <br /> / C_)/y y * by Varia ,..• (t ) <br /> PHONE CELL E-MAIL ADDRESS <br /> 108-,tiv'rvv 16f ❑Site Planandraw�rto scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and i dimensions <br /> AGENT NAME ,CONTRACTOR NAME <br /> ry1OK k it 10. n.ys ❑Site Plan location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of <br /> 435-5"clo215-n4_'mkt ilZow,ct ,, <br /> (may stale Z ) (cay,Sake,Z ) ❑ etbie <br /> PHONE 4,,11 tom: 6-1S-17 <br /> El Site <br /> 1 <br /> look _ 7S"— 1593- . .. - .'l'' ,. Q. <br /> E-UEADORESS E-MIAEADORESS . / <br /> ❑Floor ply tO scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane,co,dane.wi,us ) <br /> PARENT PARCEL M ER: CURRENT ZONING: Acs <br /> ❑ to scy a <br /> le.®M�P i DS1/496?/9a O S 9- d Ate • .- /0,oa <br /> T Ro7` ROY bin() /9 '/: #/E '�.'h: i k' ❑D-. - .∎► '• ,. <br /> ADDRESS: <br /> JO/ <br /> d Y ❑ <br /> LOT 'SUBDIVISION San r,-, .'i c <br /> j. I!/ <br /> SION BLOCKLOT <br /> __ ,. 9 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: '7 y -/- <br /> f'�t7/C/4'e 6 v 1 !0(I n U Zoning L K� <br /> - OThis project is a new budding o stnxxure. U Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERIMiT MIMIBEit ❑ Rural Address <br /> _ .. ( � i :-•r ' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not iidudrg basement) <br /> 15 Shorebnd (- ,,7" <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ci a^.. .a t a A - <br /> BASEMENT- 1STFLOOR: _ ' (►W <br /> �� 4, TOTAL SQUARE FOOTAGE: j (slopes, . .-; • t.' ••. <br /> . . ..�,) <br /> 2ND FLOOR: 3RD FLOOR: t <br /> U R- t•. , • Survey <br /> ESTIMATED CONSTRUCTION COST: �• ♦ Nit* <br /> (Please round to nearest dour) ♦ ♦ -♦ ♦ $ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [lo ODon't know <br /> 2. Is there a wetland or iloodplain on or near the property? ❑Yes Epo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Ohio <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des D40 <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) Efres • . [].)on't know <br /> 7. Is this to correct a violation? [Yes IN • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 515-112(MOBS <br />