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c <br /> W,kk.aM 3 �' Et) L0.,\�• oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,rro Deed Restriction;CSM <br /> 9,0, (StS X 1;0o3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ���/// (k4. 4 "5334 W ;-855-8E551 ti.c1 2l2 _J d... Elate-Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> E PN1;.**k%)CZy �; V Ca\CA WAN$ de Plan including location <br /> AGENT ADDRESS I CONTRACTOR ADDRESS of well/septic <br /> 3$3y C e.\Z ia.d 383.k E 4J��z a d s S <br /> v(City,State,Zip) (City,State,Zip) <br /> PHONE PHOKE ❑Site n royal from <br /> i%C'al--`•13 c0 <br /> 11Uoctco appli township. <br /> E-MAIL ADDRESS E-MAL ADDRESS <br /> -- _' a ‘ ` rY.t.�v(otin Ec:�)t.,JrL Ls '� fit,U.f,le r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) EPARENT PARCEL NUMBER: CU Z• 1 G: ACREAGE: <br /> ID NUMBER 650jngo�- y11040"6 R r -r a,gS drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 411101 a '/a: 1`k N 14%: &lE riveway permits <br /> ADDRESS: 1 (state,county <br /> La* L W CsiskA L.A=4".e. v-A Fa O-' e-a erb-O e f' <br /> csM: \OOC,} LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits 1 �; <br /> (publi 4,• �lie V <br /> PROPOSED PROJECT INFORMATION <br /> . 7-7-77:737.--t-`','1--,PROJECT DESCRIPTION: , i g <br /> ` _ r <br /> . 1 -This project is a new building or structure. _ �} ; '' <br /> ['This project is an addition/alteration to an existing building or structure. -{ Z ; <br /> SANITARY SERVICE: PERMIT NUMBER: � `41 <br /> EWER EPT1C 13')0 tee--OOQ'A t , eve f:+. '- <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ^..7.*. £: --4 <br /> AREA TO NEAREST SQUARE FOOT: I 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) N_ = �� <br /> BASEMENT: 1ST FLOOR:A -ef 't`r t. -'' ° ` 1*• Allb <br /> 1V�4 00 + TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR _ 3RD FLOOR: — _`_ 4 , t ,4 <br /> ESTIMATED CONSTRUCTION COST: (C DO � �k . O I <br /> (Please round to nearest dollar) "'• '� $ (bO c .: S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes [}io pDon' not�l � <br /> 2. Is there a wetland or floodplain on or near the property? es Flo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es , Js o <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 �Vo ['Don't know <br /> • <br /> 7. Is this to correct a violation? ['Yes OVo <br /> APPLICATION MUST BE SIGNED <br /> 545-12 t (Continue on Back) -+ -r. -► <br />