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3 W20 111-Y1,JJ,4,;t4.rf1;11':c1�: :4 <br /> ZONING PERMIT APPLICATION www.countyofdarte.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> /1/k,►k HC/) 6 P ✓'u El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) // Deed Restriction;CSM <br /> 5.2 07 Ai, Fti.11 potri�' fR44 . /. Deed <br /> i l;1S (A-9;S3526 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> 7q 5 .113S ❑Site Plan draw scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu imensions <br /> AGENT NAME CONTRACTOR NAME <br /> '73/11 Lae/IL rr4SOn 141✓t4 4/16ak 6eira yr , u/c/*S ❑Site PIa in ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of welVs is <br /> /, o4 61 -11 b . S'?(/ L/h :n cr44 l)- <br /> (City,State,Zip) (City,State,Zip) ❑Set cs <br /> Uervtt,e y 5 35 53 Pea ii,,< r 4)j' 3 S i© <br /> PHONE PHONE C ❑Site PI.1 a e e� `al from <br /> �3 S' /� (� S % 8�35 • / Coa appli •'• - of• ' iP <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /0r, 7l a .. ^o ok <br /> _ "r.4.074.1 ❑Floor pltylsCale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of erty <br /> ElPARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> UMBER 06 0-2(02-?' / C7 5" R' r — 1 2, (/2 frontagkO6wn to scale. <br /> TOWNSHIP: SECTION: <br /> /3 er4N yi: %/4: ❑Driv er s <br /> ADDRESS: y (Stat� n ,town) <br /> 52 0 7 A)r A i it?of of f !t4. 6'Y.D3 S PlAlvt Z ❑San;. ,,{. , t <br /> CSM: LOT SUB IVISiON BLOCK/LOT I <br /> O — `7 a+ / (pus i. •,vat:, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ;Z z.f'' x 2-4. -De fct`C ea CAI /Aye ❑ Zonin t 'rict <br /> . EiThis project is a new building or structure. ❑ Permitt <br /> This project is an addition/alteration to an existing building or structure. laV <br /> ❑ °t <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUrat Add i;. a410M4 <br /> EWER PEPTIC (newle meting) V , <br /> HEIGHT IN FEET/ 1 f� NUMBER OF STORIES: (Not including basement) <br /> /2 A-V) ` 1 0 obi yo ❑ • ��e . .j i Shore? e ,,,-.ment AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Eros. <br /> O intro! -`rmit <br /> BASEMENT 1ST FLOOR: <br /> L' 2(0 j TOTAL SQUARE FOOTAGE: 4 (slopes,d • U),•nce, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/a r- <br /> ` 7 6, ❑ Re A 4 .. Survey <br /> ESTIMATED CONSTRUCTION COST: and a 'l ' ,=o• •ns. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �� v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ! n now <br /> 2. Is there a wetland or floodplain on or near the property? . es Q o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des ►.� o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des ❑io <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) es o UDon't know <br /> 7. Is this to correct a violation? Des o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ■ -► <br /> cac.11',um\ <br />