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tieci,, ilr:2323zoimon <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zonin•; - US' UP; <br /> 9y/O , ,-feS/Le.v�." �j e /eta S3SGc Deed ''i ict SM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS �� Varian e <br /> Low) S'-'7,63® (,at- feY-7.3'e , " / BFI` ei'"t ❑Site Pla d - • scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl .' i sions <br /> AGENT NAME CONTRACTOR NAME <br /> 0-1r Q-1-1 2 4.i ) /( 4L _A.v ❑Site Plan inc uding ocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we /s tic <br /> (City,State,Zip) (City,State,Zip) <br /> Set cks <br /> PHONE PHON ❑Site Plan I from <br /> ( '&) c'N-O — 6 �J`/ applicaf e n hip. <br /> E-MAIL ADDRESS ,----___2 E-MAIL ADDRESS i/04-1.e ._ <br /> T sovi@ mac`-'e'"�'r ❑ Floor plan scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usf) <br /> PARENT ' PARCEL NUMBER: CURRENT ZONIN ACREAGE: ❑ Elevation of•'•perty <br /> IZURrvicsEELR °gQ$_3/01-?-0 , fronts.- L. ... • <br /> TOWNSHIP: SECTION: 1 ex,/ 2' 8 " II Driveway permits <br /> ADDRESS: (state c. • • <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> El Sani rmits <br /> A�� k n P.n.� (public rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> i on, 5-i-17 lie -�` 6, P�0.-,..e D Zoningtr tct <br /> ---19:rhis project is a new building or structure. <br /> ❑ Permitt i se''° <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address ;.v <br /> EWER MEPTIC r /existing <br /> H IGHT IN FEET: r NUMBER OF STORIES: (Not including basement) _ <br /> -g�4,p it r)1 (,4 ._O-- 0 wetlan / 1 •,slain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorel is Chment} <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r <br /> BASEMENT: 1ST FLOOR E[OSiO C• • 'emit <br /> 3 6,) 3,5-<4 > 4, TOTAL SQUARE FOOTAGE: (slope , • - 1' •ance, <br /> 2ND FLOOR: 3RD FLOOR: fillmgl•CceSSj <br /> 7�7 ❑ ev' / ocation Survey. <br /> ESTIMATED CONSTRUCTION COST: r.• options <br /> (Please round to nearest dollar) ♦ "'io. • "'0. 'i ■ $ yj'p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ... go QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes efiRlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes I�IIo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes [tcto <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) EYes _EiNo ❑Don't know <br /> 7. Is this to correct a violation? EYes RI <br /> &Dtkoc-1-1 071 [0 S` 5. +-e PLIuATION MUST BE SIG D <br /> 545-112(4/08) <br /> Continue on Back) -► -► <br />