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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPUCATION wywicountycidanecom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER AME ,1o�` L el, <br /> 1046 VO <br /> �Y(fl� Q//. Zoning Status;CUP; <br /> ER <br /> OWNADDRESS (Num ,Streett, , Lt,City,Sta e,Zip / Deed Restriction;CSM <br /> '2j'c�- K`-Cl I , tf .('.fr �� 1 / L"u 72-,-C-3 ' Variance(# ) <br /> HOME PHONE CELL'20PHONE 1r J 9 E- •ILA( VU( 1 r lite Plan drawn to scale <br /> (�.(hJ 'I 0� ((' Vl�(n �i'"5 1. � tat. C.�J <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> / 1y.Oi.4(i1 f.• — /Joi' L/f, to Plan including location <br /> ONTRACTOR ADDRESS 1" of well/septic <br /> AGENT ADDRESS C,-c e_.'e_� <br /> 3ar� etbacks <br /> (City,State,Zip) (City,State Zip), �-�2 <br /> �L /(A). _S`�' ( <br /> El Site Plan approval from <br /> PHONE PHONE applicable township. <br /> E-MAIL ADDRESS E- •ILADDRESS t <br /> i , P ( r � f ' p oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.L:o.dane.wi.us/) [`�Elevationofproperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE' ffOnta a drawn t0 scale. <br /> _ i3 _ jFR1- ue5 <br /> NUMBER �� �� ��'�L � �� � <br /> TOWNSHIP: �+ SECTION: riveway permits <br /> lA t,r.(i1 ,�,11 'i4. '/4. (state,county,town) <br /> ADDRESS: t <br /> c - t oy\ §_t D‘anitary permits 3 BEDROOMS <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> ( 122►4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ❑ Zoning District <br /> a)1 )A. 5(ilk- )�tti14(1 07�l2 , <br /> • nThis project is a new building or structure. U Permitted Use? <br /> [This project is an addition/alteration to an existing building or structure. ❑ Rural Address <br /> NEW <br /> SANITARY SERVICE: fig;., i �t /l © (new/existing) <br /> .EWER EPTIC ` O <br /> NUMBER OF STOR ES: (Not including basement),,„. .,„ ,-,--1--,-.--, 0 3 ct- <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErOSIOnCo tfol permit <br /> ' <br /> `� iT .,1� /% l1r0y< " ' • to j • TOTAL SQUARE <br /> FOOTAGE: <br /> < i `` % (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOO'- 3RD FLOG' <br /> '� ,1-44 14 <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: available options. <br /> (Please round to nearest dollar) -iii. -10. -10. ♦ ♦ 3 O I) j 0 DO t C C <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 'lo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYeso ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yeslo <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) QYes o Don't know <br /> 7. Is this to correct a violation? DYes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> REV(01/19) <br />