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ZONING APPUCAT1ON w wimcOtntyolf'oom SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME <br /> ellA B 46.va,¢e S <br /> O ER ADDRESS (Number,Street,City,State,Zip) � /ePP ❑Zoning Status;CUP; <br /> Z WO '0F 7?t rw Deed Restriction;CSM <br /> � ( ��Y3s'Z,1 Variance(# ) <br /> HOME PHONE CELL PHONE E-E-MAIL AIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> gimiuS leidoc `into S ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Q� <br /> (City,State.Zip) of well/septic <br /> 2 NT S S az„,ei LO <br /> (City,State,Zip) ❑Setbacks <br /> d <br /> PHONE f V/SOW. LJ/ S3 7/4 <br /> PHONE ❑Site Plan approval from <br /> 66/3 • £/33 , 3 7 I 1 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> view Q ' , ,is/20110. ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARC UMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑NUMBER CO D711'331-17'01-7 AN-3 8. 'd9 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Its-wia of errs-s �,e — '/.: S E V.'/.: loud ❑Driveway permits <br /> RESS: (state,county,town) <br /> CSM:�� LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> OThis project is a new building or structure. ❑ Permitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Ze I ' ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 2 3 S + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> V filling/access) <br /> 2ND FLOOR: 3RD FLOOR: Z 3 8, <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / �� and available options. <br /> (Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes 'lo •'$on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes allo V2 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ['lo <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 Elo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Vo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ♦ -t• --• <br />