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Permit No. ()/ 8'- fft <br /> WESTPORT ZONING PERMIT APPLICATION <br /> Joint Planning Area Extraterritorial Jurisdiction Area <br /> I. ADDRESS OF PROJECT: 5ba( I-r V:14 Q— IJJ - t) 5359?- <br /> TAX PARCEL NUMBER: (914 'O$bcf—All — 2dt4�l — 8 . <br /> SUBDIVISION OR CSM#,IF ANY: � 4-F 4 G, 4 - <br /> P <br /> LOT#,IF ANY: 10 cj <br /> 2. OWNER: L4L i— AGENT: <br /> ADDRESS: 56a,,fr 04k/Vic:‘," LA) ADDRESS: <br /> 3s5l- <br /> PHONE: 6©t- ails"— SCI Z-- PHONE: <br /> EMAIL: ptent.14 5.5 A C,P, .A_, &AA-- EMAIL: <br /> 3. TYPE OF PROJECT(circle one): New Single Family New Duplex New Multi-Family <br /> New Commercial Addition the _.. 4:110 <br /> COST OF CONSTRUCTION:$ 1�3-0,0 SQUARE FOOTAGE OF PROJECT: ' <br /> ZONING CLASSIFICATION: retv,,, •... SETBACKS: FRONT_15___ REAR i 0 <br /> Ite iz " 64, to eon hc,,,,,vit . LEFT n o RIGHT 6 1 <br /> 4. SITE PLAN, *A site plan must be drawn to scale showing the lot lines and to lines.ens irocaltien�an size of all existing <br /> FLOOR PLANS& and proposed buildings or additions and their distances from lot <br /> ELEVATIONS: the location and size of the on-site septic system and the location of the well shall be shown on the plan.A <br /> copy will be kept in Zoning Division Files. Example of Site Plan,Floor Plans&Elevations attached. <br /> 5. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? 0‘,1 v <br /> STATE SANITARY PERMIT NEEDED/ YD IF YES,PERMIT# <br /> 6. SHORELAND? Y 6 FLOODPLAIN? Y f N/ WETLANDS? Y/0 <br /> T SIGNATURE: 1 4-5- Date: s /20 id <br /> APPLICANT/AGEN <br /> For Office Use Only: <br /> ZONING ADMINISTRATOR: . ' DATE '5175J/ I' <br /> FEE: <br /> (1 .--'7• RECEIPT No: <br /> ORIGINAL: WAUNAKEE COPY:APPLICANT • COPY: WESTPORT INSPECTOR <br />