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i tkit kve A 3inj <br /> 11- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-Apo # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ( F ,Co)o-Af.✓ e S 6w ❑Zonin Status; CUP; <br /> OWNER ADDRESS'(Number,Street,City,State,Zip) /-,y► D , d estriction; CSM <br /> Mr / 4 GT.E'CGE 4/42'5 CR J-iv 5_i CY8 Van ce(#� C )a" /. <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6- `6// - . ehlerir,d6rie ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 2e Joc,, ycge )ry9t,s,.,,,/ ❑Site PI In ¢jfiplocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well se i/ <br /> hiY r-t AcraSE_ i2..b w 8"31'1 /No2Se Pj <br /> (City,State,Zip) (City,State,Zip) ❑Setb s <br /> PHONE PHONE ❑Site PI a I from <br /> do,- ,(?j- 7�o Y �'8—6-55--- 71o�f applic�bl�toi4nsf�ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plansstg4cale <br /> tJcH.�io,J - epee_ •- Mtn:Cv. fJt;Nr igc. Kot,L v�c0foc. .t � , . (/ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevati property <br /> ❑NUMBER p�/to"-a,i3--636 y -o g-y frontage raven to scale. <br /> TOWNSHIP: SECTION: <br /> ,,/ /)50,2 �t 1/a: S W/a: ❑Drive y is <br /> (stet c , n) <br /> ADDRESS: //'' /p f / * C rct,S�j &i- ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT • c,private) <br /> 31 ,20+s e/Z41.✓ 3 y <br /> PROPOSED PROJECT INFORMATION STAFF ft ' <br /> PROJECT DESCRIPTION: <br /> V 'v G,�.s ,,cr.----c CI Zoning <br /> E.This project is a new building or structure. o Perm se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITA YQERVICE: PERMIT NUMBER: D °t -( r ess <br /> al -\O EWER nEPTIC ( " /existing) <br /> VIIHEfGHT IN FEET: i C). NUMBER OF STORIES: (Not including basement) <br /> /b pe-AX OC i a e`8 <br /> ) <br /> AREA TO NEAREST SQUARE FOOT: ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> Q E + '. a" _ . �l'tnit <br /> BASEMENT: 1ST FLOOR: <br /> fP 70 TOTAL SQUARE FOOTAGE: 's ° ` ' '` ` <br /> Y7 All. <br /> 2ND FLOOR: 3RD FLOOR: <br /> 906 v 3,966 <br /> ESTIMATED CONSTRUCTION COST: Q /�, s3„7 &KJ 1 4...t, 0 <br /> (Please round to nearest dollar) $ (� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ales ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes I No <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) BYes Do ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Eallo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) = = = <br /> 545-112(4/08) <br />