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q F ' t st3 <br /> ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 5pro)C'1 LL C 3 Zoning Status;CUP; <br /> O ER ADDRESS (Number,Street,City,State, <br /> 2(7Z m , I G�'�O - to S37# Deed Restriction;CSM <br /> 1 ! 1(� J � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL•"DRESS (� / <br /> (0g:` . 2. I I r i Q O V • ► 1 i�'S ®Site Plan drawn to scale 1,7-'' <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions ✓✓✓ <br /> AG T NAME CONTR. TOR NAME <br /> b.. 4 i " q A.,- f, „ 0 `igtN,©LL L. Site Plan including location , / <br /> AGEN ADDRESS CON •, TOR ADDR SS of well/septic V <br /> Z 6 i W N w y 1)1 61 2 q 2 i y /inn/ <br /> (city State,zip) (City,Stat ,Zip) Setbacks'J�z VI: I/J) 5 E9t Nal, W r 53-7-ti <br /> PHONE PHONE C��/ Site Plan a.��v.l`..: <br /> C,U8 - (436)-2-?3,b �p,0, " �2 - 2! ,6 applicable • , • ip. <br /> E-MAIL ADDRESS r- - _ E-MAIL A DRESS r_ / <br /> n- (1 a Od4e eJ S, C/r1 d Pt a Q-I'� r)i ftsi u Floor plans to scale v <br /> PROPERTY/LOCATION INFORMATION (http://4ccessdane.co.dane.wi.us/) Elevation of property <br /> � <br /> PARENT PARCEL NUMBER: CURREN ONING: ACREAGE:tif <br /> ❑PARCEL 0' 8_30i_� � ;/ <br /> ell�[11 I 'a-74 frontage drawn to scale. AZ <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> r1/1 t 0 0 L.ETIA '/a: y : ElDriveway <br /> ADDRESS: (state,co n) <br /> 7-7O a "t/ , Sanitary <br /> CSM: LOT SUBDIVI-ION I BLOCK/LOT <br /> (public,pr <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION t <br /> RCS t za.Li a r�q� in r �r/ 0 zoning. <br /> . This project is a new building or structure. 0 PBrmiit 6 <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: © - ° tAddress <br /> EWER VIEP{JIC I I r 20(.. — 0102-3-3 - 1`+= -3 <br /> HEIGHT IN FEET: ( �,► ^ NUMBER OF STORIES: (Not including basement) <br /> ?i ,i'JT`11� <br /> AREA TQ NEAREST SQUA-E FOOT: Sre <br /> (Outside dimensions including unfinished area, attached ga ages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1 etd <br /> I (� �j Q(_ ! 4 TOTAL SQUARE FOOTAGE: , (S " _ ' 3 <br /> (VP C� l 1�/ i <br /> 2ND FLOOR.Z / 3RD FLOOR: 6,9 T 77 a <br /> ESTIMATED CONSTRUCTION COST 0 Re i7 .4t---- Y <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ ♦ � �� f ' <br /> 1. The property is within 300 feet of a stream or 100! feet from a pond or lake? QYes 2 o IDon't know <br /> 2. Is there a wetland or floodplain on or near the pro 4erty? [Yes o (Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? es Olo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) , 'es E10 ['Don't know <br /> 7. Is this to correct a violation? [Yes KiVo <br /> AS BID <br /> (Continue PPLICATI on ON BacMUk)T —►E S GNE <br /> 545-112(4/08) <br />