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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER.NAME J �1 <br /> (2h At.l'/ sz Bei MI i-t hih.C-4/�, y & '. 7 K $/ ❑ Zoning Sta us; CUP, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) n O Deed Rest •cti , CSM <br /> S/73 J B f ti-m oa.� i-t h f/'4;Pla'42 ...5-3-5-Y a Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (Y. - b 6 1 ' 7 - - _ ,i 1 ❑ Site Plan drpwrOescale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and include imensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ps b BLt/ di• N- b•Si` ti ❑ Site Pla in ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS I of well/s tic <br /> (City,State,Zip) (City,State,Zip) ❑ Set ks <br /> Meti Lei II, WI s'" sfs9 <br /> PHONE PHONE El Site PIS i' va1 from <br /> ("01- 0,c-5---- 77?/ applic w ship. <br /> E-MAIL ADDRESS AILADDRE S / ./ ��, ❑ Floor pl o scale51? <br /> s e Ar;I,/fir/ �' ' ‘ 1t1 -Ga( • <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.cc dane.wi.us/) <br /> PARENT PARCEL NU,M«BBEER: CURRENT ZONING: ACREAGE: ❑ Elevation f grope <br /> ❑ NUMBER C `OM0Ni2` D L� — / (�qa /Lief,- frontage d w o scale. --c <br /> TOWNSHIP: /� r SECTIOI : <br /> ,., /�r1z,'h, .5 W 1/4: ii)61) 1/41/4: ❑ Drive <br /> ADDRESS: (stat ty,town) <br /> •5/7; ,23 V.07 / 1)404 cJLUI iica-ik)'e S3.s9 0 El Sani its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pubt c, V te) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 3^- t <br /> is a new building p <br /> ❑This project 9 or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: , <br /> nSE - ;ry EPTIC (nom <br /> HEIGHT IN FEE ^ ,, NUMBER OF STORIES: (Not including basement) %, N <br /> ' -(1‘0 I G :i <br /> f <br /> AR J-. e <br /> NEAREST SQUARE FOOT: <br /> (Outside dimensions inc 1.• • in'fished area,attached garages and above grade decks or porches) '' <br /> BASEMENT: 1ST FLOOR: !,' <br /> -5- Y� 4, TOTAL SQUARE FOOTAGE: � '�„ r aft >, , <br /> '7 � i <br /> 2ND FLOOR: 3RD FLOOR: ,5-11� <br /> ESTIMATED CONSTRUCTION COST: �� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "∎ ♦ j � �„ ,', <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes Cgl No <br /> 5. Is this project associated with a rezone/CUP/varia ice(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes KNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes .0,po <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ♦ -► <br /> 545-112(4/08) <br />