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SUPPLEMENT to Web-App# <br /> ZONNG PEFIVIT APPLICATION v�nnnneoarrtylofdane.00m <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME L <br /> EF� JA/'I)j'4// - ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Z. / / / Deed Restriction;CSM <br /> 17'f/ WI 1,-ppivfgi Wigy Cor1-46i 4Jt 0✓F W IS-1527 Variance(# ) <br /> HOME PHONE Q <br /> • CELL PHONE E-MAIL ADDRESS <br /> or <br /> ' 72 V ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGE T NAME CONTRACTOR NAME <br /> �'VJ� ARstN eR/ 41/014e/S045,1 ❑Site Plan including location <br /> GEN_TAADDDRESS CONTRACTOR ADD ESS of well/septic <br /> / o9 MTEAtifSt bR• S747 4uNNPR(jb R• El Setbacks <br /> ONE f4d4 W� S35/3 l �lt, -" . 53Sgl El Plana royal from <br /> PHONE PHONE pp <br /> .3 ' ' le (`j gj -33:s- , applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> e H RA4-X6 v - ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRFONING: ACREAGE: <br /> ❑NUMBER 17 7f/1�S2/.S(O,S A 1 s (V3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 6.0 rrA6� 4Ro ye %: '/%: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 'f?W W w4foRE t4/A I/ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJE T DES RIPTION: / <br /> 'X /�t / �� ?`� 4 ARA 4 p U- Zoning District <br /> . <br /> This project is a new building or structure. © Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address i p <br /> EWER SEPTIC (new/existing) f' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Wetland/Floodplain/ ate. <br /> AREA TO NEAREST SQUARE FOOT: \ Shoreland (attachment <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT: 1ST FLOOR:S i °° LLLIII <br /> 4, TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0 NS1 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �+ f7 and available 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? [Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Ro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes o <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 /> s <br /> 6. Is a location survey required? (see reverse) :Yes o ❑Don't know <br /> 7. Is this to correct a violation? Elves ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -► <br /> 545-112(4/08) <br />