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$' (o7 , 2-a <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA NüR8 <r `,0 li,x l R EI S ❑ Zoning Shat ,CUP; <br /> OWNER ADDRESS (Number,Street ity,S Zip) / ? Deed Re rI�C ction; CSM <br /> 1 �—I 1 O C�,X �CSt��IJ� W �3 SJ 4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 1- i/ i - 1• 1 . #8-,-.,1 -1N• ❑ Site Plan yawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and in des dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site I ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of e e tic <br /> (City,State,Zip) (City,State,Zip) ❑ Selg6CKs <br /> PHONE PHONE ❑ Site Plan •*;i••val from <br /> applih•I. • ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor s to scale <br /> PROPERTY/LOCATI[O�N INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation property <br /> PARENT❑ NUMBER <br /> RC PARCEL b 5'NUMBER: 25 `f7cr CURRENT ZONING:3 ACREAGE: 3 fronts drawn to scale. <br /> TOWNSHIP: SECTION: <br /> M \ <br /> ) 0-Y-1 1h: 1/a1/a: ❑ Driv € ��;er•.its <br /> ADDRESS: (st e . • y,town) <br /> 1(7 °1 5. eyof - Ir . ❑ Sa . . 11 permits <br /> CSM: LOT SUBD,IVI,sI• 1 i BGLOT425 (pea,private) <br /> PROPOSED PROJECT INFORMATION STAFF d) <br /> OJECT DESCRIPTION: <br /> V4 kt°0 r 12 X i s 00g no ER GkoS 4 bi` rc p-vh U a ,, <br /> ❑This project is a new building or structure. U er U.tse? <br /> ixiThis project is an addition/alteration to an existing building or structure. F : <br /> SANITARY SERVICE: PERMIT NUMBER: *Rural •• « '� <br /> ����:, �, `rte'.. <br /> SEWER SEPTIC / . 0 4 r, <br /> HEIGHT IN FEET: 'ly, NUMBER OF STORIES: (Not including basement) <br /> ( ' . 4We s t i.i € <br /> Shorel € (a ,-« tent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ri <br /> BASEMENT: 1ST FLOOR: C tr41.,• s `' <br /> TOTAL SQUARE FOOTAGE: ,d roan s, <br /> 2ND FLOOR: irk(a 3RD FLOOR: '1.k ( „ . , <br /> ., s I Su y <br /> ESTIMATED CONSTRUCTION COST: `' € :€•€• <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 ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ♦ ■ <br /> 545-112(4/08) <br />