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1 <br /> Li Z( <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 331,^ K.1_ C4h iAL , bo661\ <br /> 5 V41 it{ Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> (491 VI 6(NIA Vft.e PICW I Dre 1 lAI_!_ 5-3 5 7S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0$-8S--a53S (6O$-c—1 -75.41.0 ' d.o6(,05k @C6-r4er,IA eo- Si Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd include •*mensions <br /> AGENT NAME C NTRACTOR NAME <br /> bds h B . LL gi Sit- - .n i•- 'sing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 1V2775 G1�y K..! :.w =T <br /> (City,State,Zip) ) (Ci ,State.Zip) N - •acks <br /> r.PHONE \ PHONE [VSi4ePlan approval from <br /> 92f:3 - SrP 3 -3 t/4 f applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mow'`"`ce_t:05e4 c• I 10,..c 11„,,,_>. e,-. [ .oer-plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �Of property PARENT PARCE NUMBER: RR�jNTZONING: ACREAGE: p p y <br /> ❑PARCEL 04� ID s 1-0611-13)-0-1 /-{ — frontage drawn to scale. <br /> NUMBER / �6n �_ <br /> TOWNS\HIP: ECTI <br /> I )��S`�r 1�4.5 E 1/41/4: Drive its <br /> ADDR�E/ss: (state ty,town) <br /> /O q See, (Jai/ Pk ivi <br /> CSM: LOT SU IV 7 San p Its Q <br /> !VISION BLOCK/LOT <br /> (pub!' , • te) ,)//4/ i <br /> PROPOSED PROJECT INFORMATION ' ST FP VI <br /> PROJECT DE IPTION: ; <br /> Kes c,cGes mil,! ”• `� . >� „ ,,,,, : . , <br /> This project is a new buildin or structure. J 'Use,/ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ©Rural ”,. <br /> EWER ='(new/:,;TITria ; ,.. <br /> FI <br /> HEIGHT IN FEET:, NUMBER OF STORIES: (Not including basement) <br /> 2 S S-� I • `_i 1 l�� .ee a <br /> a • , m' . ,t flu ent)," <br /> O NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOO: • � "� ;re' ���" <br /> 0 ) ZOO %)'c 4, TOTAL SQUARE FOOTAGE: 4, (S S,,- - I `,,,« y <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3) 2°° , II . , . <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ .7s_)v 0 s "1. ( s. <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 kno <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? 0Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes giNo <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 EINo EDon't know <br /> 7. Is this to correct a violation? Elves EgNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />