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ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> S vE fA1/4/1.E. oni atus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Striction; CSM <br /> 3515—g y 1e 0/5w / h'1 r, /l dre�' Varia ce(# ) <br /> HOME PHONE CELL PHONE E-MA} J DRESS <br /> E -2,--279i '�air 4 Tpf . r"E T L $ik Ian drawn to scale/ <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME _ CONTRACTOR NAME <br /> 0(4,1C / Aig C &ST �i--C w )T/ Giif_ST101.2c-r, ,✓C kerePlan including ation AGENTADDRE CONTRACTOR ADDRESS well/septic IN <br /> P 0. e' ox / Z S// acks <br /> (City,State,Zip) (City,State,Zip) <br /> er,: //b . £-v/ Jp-5-7e _X, 2` <br /> PHONE / PHONE ❑ Site - ; -'• oval from iim <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> QLaf/E we 9rftcUg/►4"/t • C v`"t -5.4-'r'',� loor plans to sc e Ab <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) y <br /> PARENT PARCEL NUMBER: CURRENT ZON VG: / ACREAGE: evation of property <br /> ElPARCEL C/p6-36y-cz $> 0-0 ,A z ) -793 �,` 9 a /V /- frontage drawn to scale. <br /> NUMBER "/ O "6 ! r'/ J <br /> TOWNSHIP: SECTION: r <br /> & C4 E 11'I b u NQs 3 D 1/a: SE 1414: ,$G✓ ri - / '-rmits <br /> ADDRESS: (stag ) • '•wn) <br /> 3 G q 3 Ryc RA �1 itary permits - <br /> CSM: LOT / SUBDIVISION BLOCK/LOT (public,p i at r <br /> 139 � � <br /> PROPOSED PROJECT INFORMATION STAFF RENT <br /> "�� <br /> PROJECT DESCRIPTION: ,� -� f����k �-} :.1-_,i, � x <br /> S'-i,,.'G L E f%y/l y fl ', -k- V''7oning ® s i60-' 1 <br /> • [Ti This project is a new building or structure. ?I' i o use/ , <br /> ❑ project g building '. <br /> This ro ect is an addition/alteration to an existin buildin or structure. � �� � <br /> �Ad. es E <br /> SANITARY SERVICE: PERMIT NUMBER: ,' , <br /> SEWER SEPTIC /3 . 2 CJ/ (� (, 2 ? 4 , �;, ex g} �`'1 <br /> HEIGHT IN FEET: NUMBER,OF STORIES: (Not including basement) "--i' ` <br /> zz fs i4./G z R . 4, <br /> or a r en <br /> AREA NEAREST SQUARE FOOT: :°' -':' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 4° s�°;it o + <br /> BASEMENT: q 1ST F OOR: ' -= w <br /> / j TOTAL SQUARE FOOTAGE: 1 O+e °iS +I @ 1:3 ,.145, <br /> 2ND FLOOR: 3RD FLOOR: S S M + R,:a-' <br /> �/ e <br /> I �S � ��'`�� ��`� 6t o ire -i A' <br /> ESTIMATED CONSTRUCTION COST: i 2 e 1t ++i <br /> (Please round to nearest dollar) —, -► t-H.- ♦ $ 1 Q ,� Z >� ,,-4 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? M Yes ❑No ❑Don't knov�5 <br /> 2. Is there a wetland or floodplain on or near the property? El Yes ❑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 pro erty in the past 5 years? ❑Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/v ' ce(p titio /ap eal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) 10 .. f Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ —► <br /> 545-112(4/09) <br />