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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> LS/s)Nctrll t-sysa 6 'rev s°r- Waning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 08 C-xtE52-;*; - s-- /449-13 0A t �1Z. Sr37t I Variance(# ) <br /> fHOME PHONE CELL PHONE E-MAIL ADDRESS <br /> "30 3 - - '' ffe Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> Ali.57. 1 uc7ucS (Yip X.J C ❑Site . ciuding location <br /> GENT ADDRESS CONTRACTOR ADDRESS of /s tic <br /> (City,State,Zip) (City,State,Zip) [ fbacks <br /> J/17YN cl.'Trt I us I 5.-35.5-3.— <br /> PHONE y� PHONE aSiterPlan approval from <br /> �"` 68 7/7'f — gCKV applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r /bs>c.0Octo2S'PO,COM oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) <br /> EIPARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: ElAteraiien of property <br /> NUMBER OA 661 o-0$�-0�3-.� e- Tj , ,y, frontage drawn to scale. <br /> TOWNSHIP: SECTIO ,�� <br /> ,J,J ,/: ,/4,/. Drive permits��1� <br /> ✓ADDRESS: OUnty,town) <br /> Dei (fri` Sr v Sanitary permits`� <br /> CSM: LOT SUBDIVISION BLOCK/LOT \ <br /> PROPOSED PROJECT INFORMATION MOW MEVNEW <br /> PROJECT DESCRIPTION: <br /> , 940772a✓ //2F Ple0fz-t ateling District <br /> ❑This project is a new building or structure. C> - rmitted Use?' <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB R: taoRdral ' a0, a. <br /> REWER e9 ( = <br /> HEIGHT IN FEET: NUMBER F STORIES: (Not including basement) <br /> i 1 P • a _ 44, 4a• I,sin/ <br /> oS S a era® .fl chrrl@nt) <br /> AREA TO NEAREST SQUAT E FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rosto Control <br /> BASEMENT: 1ST FLOOR:. permit <br /> 1✓'{ 4, TOTAL SQUARE FOOTAGE: 4, (sl,,opes,dis JIbancey <br /> 2ND FLOG 3RD FLOOR: ling/a ) <br /> ` { view Location Smelt <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ / '0 and available options. <br /> (Please round to nearest dollar) <l9 0 00 <br /> 1. The property is within 300 feet of a stream or 10001feet from a pond or lake? JYes ONo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'Jlo <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) 4 'Ryes JNo ['Don't know <br /> 7. Is this to correct a violation? Dies Ealo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - —► <br /> 545-112(4/08) ) ♦ <br />