Laserfiche WebLink
' C‘)Gil- zpitk 7.2_, 00 <br /> \ ) INK. g261. - i-1--2-.0 ci 1 f-e,{ t/1.■ L _ <br /> Ach P 41•P <br /> r SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.co tyo ne.com <br /> PROPERTY OWNER INFORMATION OF ICE USE ONLY <br /> OWNER NAME , Q <br /> 1 4A/E pig E -/-5011) 0<aAreil Zoning District <br /> OWNER ADDRESS (Nu ber,Street,City,State,Zip) /^) /f n/ <br /> S"10 a g Sd i'aJ KD C, 8-4-1/�IT- ' 14 S S - ermitted Use? <br /> PHONE p E-MAIL ADDRESS <br /> 796 ' 0 tng Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> Deed fkes#nction;CSNI <br /> AGENT NAME CONTRACTOR ENAME /) �� c <br /> AGENT ADDRESS CONTRACTOR ADD ESS Plan:°d n to scale <br /> ,Site and includes dimensions <br /> (City,State,Zip) (City,State,Z Ziisp) �� <br /> V 1° �°� 36.93 tie Plan including location <br /> PHONE PHONE <br /> o1S4, _ /33-.S— of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I ". to Plan approval from <br /> PARENT PARCEL NUMBER: ZONIN ACREAGE: <br /> PAR i j) i applicable town • • <br /> D NUMBER D8"1 -154- • 010 g <br /> TOWNSHIP: SECTION: <br /> eEaLR y/ 15 1A: '1/41/4: P Rural Address t•/,ei(�� <br /> ADDRESS (new/existing) , <br /> 56., a. hk ma Rd C►ti55 la a175, 535 i <br /> CSM: LOT ' SUBDIVISION BLOCK/LOT ���oor plans to scale <br /> 0 et tevation`of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION. <br /> c x LJo PoLe j Lo,NI <br /> riveway permits <br /> - WThis project is a new building or structure. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER.r nitary peace) <br /> SEWER SEPTIC <br /> Nf� (public,private) <br /> HEIGHT IN FEET.` J/��/ NUMBER OF STORIES: (Not including basement) [land/Floodplain/ <br /> — I Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) L ErosionControl permit 4..( <br /> BASEMENT: 1ST FLOOR: <br /> 1/A ci /1 , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR:,V 3RD FLOOR- <br /> filling/access) C <br /> Ay w� Q� ��,, �// ���k: <br /> Ny4- // / D 11/Review Location Survey <br /> ESTIMAT CONSTRUCTION COST: -0. and available options. <br /> (Please round to nearest dollar) $ ��• Q 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes L 'Jo J Don't know <br /> 2. There is a wetland or floodplain on or near the property? J Yes 'No J Don't know <br /> 3. Have you talked with the township about your project? �++yy gYes No <br /> 4. Has there been a zoning permit issued for this property in the pas i.1/ Yes No <br /> 5. This project is associated with a rezone/CUP/variance(peti ) (leave blank if none) <br /> 6. Is a location survey required? _3 Yes .ia No J Don't know <br /> 7. Is this correcting a violation? .A. �U�$ JYes '54No <br /> ppR <br /> �DEIS•114APPLICATION MUST BE SIGNED <br /> 545-112(110 <br /> �� yPlAKN1NG (Continue on Back) -I► -. -► <br />