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I'30■ 23 - ° <br /> ZONING PERMIT APPLICATION www.countyofdane.com S SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME rr <br /> I I eA Gr ipe <br /> ❑ Zoning Statu ; UP; <br /> OWNER ADDRESS (Number,Street,CO,State,Zip) Deed Iction; CSM <br /> />LiL/ Cc, > _'i <br /> '1— ' � <br /> h '` '' /4 Variance(# ) <br /> HOME PHONE CE ONE ""E-MAIL ADDRESS <br /> (Oa -90 963' ❑ Site PI'n awn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ( <br /> X311 WWASN13u►Z�y ❑ Si,:�y�•w i 4i2i t0Va" u i <br /> AGENT ADDRESS CONTRACTOR ADDRESS of !7- a is <br /> G-7#1.9/.9 Am et f-e"G n 5-k, ® �I( <br /> (City,State,Zip) (City,State,Zip) Setba s <br /> -Zh o,i j kzr- Cim 2C® <br /> PHONE PHONE <br /> -n Site Plan ppi m <br /> 607- 2 (5-- 96 I b applica ns ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 74Ler`v_sa G✓ S L Lca�,,L'Thj 4--, (,,`❑ Floor plans cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ErPARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of p perty <br /> PARCEL COZ_ 0 'f 2 _ og5r-e6 9 //�J /- q` 9 frontage r n to scale. <br /> NUMBER I / <br /> TOWNSHIP: SECT!: <br /> t l ?5"5-1 Z'/4: iv I '/4'/4: 5 C/y ❑ Drivewa per is <br /> ADDRESS: (state, C ty,town) <br /> (°(C)Lizi caf'' l> y) 4y A <br /> CSM: LOT SUBDIVISION BLOCK LOT ❑ At pW■ fall <br /> PROPOSED PROJECT INFORMATION STAFF RE v J� <br /> PROJECT DESCRIPTION: <br /> Pope S u i e . Ice► ❑ Zonintrict <br /> t ` <br /> ./ ein This project is a new building or structure. <br /> ❑ Perktted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> nSEWER fSE (new/e I firj ) <br /> HEIGHT IN FEET:��t f �^ i NUMBER OF STORIES: (Not including basement)E./�L7 G RK _3 Wetlands/ onplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreld6d (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ECOSIO On permit <br /> W G{ f�v 1 TOTAL SQUARE FOOTAGE: j (slopes Isturbance, <br /> lY filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> (0 -17• S-P ❑ Review .: .n Survey <br /> ESTIMATED CONSTRUCTION COST: i ,� and ava : :. ons. <br /> (Please round to nearest dollar) "♦ ♦ ♦ ♦ ♦ ♦ $ Z)t oto <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IN No El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I]Yes n No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IS-Yes n No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ElNo <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) Ekes 'IgNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes pj No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) —* —0 ,— <br />