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0-4) 24 v'. 6 D (.52z <br /> ZONING PERMIT APPLICATION www.countyofda e.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> �i4 �C p�v D �1r►v�lr4 �ppt?r✓ l ( 2,Z2 ( / <br /> �t ❑Zoning Status; CUP; 'r <br /> OWNER ADD ESS (Number,Street,City,State,Zip Deed Restriction; CSM <br /> 1/46411 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .3 ❑Site Plan awn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in des dimensions <br /> AGENT NAME ��Qp C TRACTOR NA <br /> 45'O� iriou/s✓ 4471& rr tindorSoil ❑Site Plan incIN4 location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of Pll/septic <br /> (Ci ,State,Zip) (Ci State,Z� ❑ Se1Cl(S <br /> -,,y • �- 5�524 <br /> P ONE�� �I PHONE / ❑S. e aft•'royal from <br /> Otv006 J 'ISIS'-62-5025 ( ') WS'_025P-5- :. a. a .wnship. <br /> AILADDRESS E-MAIL ADDRESS <br /> ❑ Floor ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevati property <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER e02 0.5/2...77/4401-d 4. e>30,-74 frontage raven to scale. <br /> TOWNSHIP: r SEC11 N: <br /> i¢t �/ 2�'✓ , ,/4,/4. ❑ Drivew y mits <br /> ADDRESS: /✓ (State, unty,town)44 Lf <br /> 4(19ithet • ❑Sanitary permits <br /> CSM. 15 LOT (70"."' (public,BLOCK/LOT <br /> (public, private) Till <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT <br /> LC.�VCRIPTI Z C�`_ r l `LTr ov. k . <br /> Jf�',_j_"�t.�r " r ❑ Zonin �stnct <br /> . 2This project is a new building or structure. ❑ Perml Use? tit <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> XEWER [EPTIC /,fit a existing) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) � 4 <br /> l4 14M-41-4(1 ,Z ❑ X111 ; •-..dplain/ <br /> S . .chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gara es and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit 0 <br /> /6 9c, '`-• / .30 5z j TOTAL SQUARE FOOTAGE: j (slopes,..• urbance, <br /> 2ND FLOOR: / 3REALOOR:D filling =pees ) <br /> \ZS - 60& -1 ❑ Revie, •g�l•. Survey <br /> ESTIMATED CON.T- . o OST: ♦ ♦ ♦ ♦ ♦ ♦ /� l / and a a • ptions. <br /> (Please round ton .rest dollar) 8V V <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? Ekes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 21Yes ❑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) Ekes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -•i —► <br /> 545-112(4/08) <br />