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ZONING I V V 7O SUPPLEMENT to Web-App # <br /> G PERMIT APPLICATION www.countyof ane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN KR NAME-1 0 <br /> 141 no (U c O l&e--- ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ELA\O V tk\\.eVariance(# ) <br /> HOME PHONE CELL PHONE! E-MAIL ADDRESS <br /> e n,-.1,Q l' 0 8 L I 4 VS-Z%f o-i(4 5 1 o ,a si-r€asp q) ( a f k , nom+ ❑ Site Plan cr n to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plading location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se tic <br /> (City,State,Zip) (City,State,Zip) ❑ Set <br /> PHONE PHONE ❑ Site Pll*i ds f • ,-I from <br /> applic b t• ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor kly<to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevat n O roperty <br /> PARCEL /� -f t (� r� fronts yawn to scale. <br /> ❑ NUMBER 8� OQ'272 V2�3 \_� RN 1 02 QCPQS g <br /> TOWNSHIP: SECTION: <br /> t;�u n D P Creo,t v\ 1/a: 1/41/4: ❑ Drive r is <br /> ADDRESS: (stat n ,town) <br /> CSM: L T 1 SUBDIVISION BLOCK/LOT 1=1 Sa ' Ver•• is <br /> 1 1 (p ,• ate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: " <br /> GetfaSe_ G Z. : strict <br /> [t This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q e mural; <br /> � <br /> nSEWER I EPTIC e` }#ne % <br /> HEIGHT IN FEET: w 1 NUMBER OF STORIES: (Not including basement) <br /> 0 <br /> AREA TO NEAREST SQUARE FOOT: el.. •€ � a <br /> ! <br /> s , , , <br /> Shor r > <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,i s t <br /> BASEMENT: 1ST FLOOR: �t, <br /> I(0 0O 4, TOTAL SQUARE FOOTAGE: 4, i it+ - ; • ire, <br /> 2ND FLOOR: 3RD FLOOR: ` ( r <br /> El R ;"eatiorn der <br /> ESTIMATED CONSTRUCTION COST: lava <br /> (Please round to nearest dollar) "'* ♦ ♦ ♦ '♦ ♦ $ 38, 000,, e O `, _,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ■o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1�' o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Mes • No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes lo <br /> 5. Is this project associated with a rezone/CUP/variance(petttionhappeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ;14 No ❑Don't know <br /> 7. Is this to correct a violation? 0 Yes R No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />