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ZONING PERMIT APPLICATION .countyofdane.com 'SUPPLEMENT to_Web.App#';' <br /> PROPERTY OWNER INFORMATION :'':iir OMER TO PROVIDE <br /> OWNER NAME / <br /> ,5—T v pI �°`7 L '= k/ Zo ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> / 9! J`cI'Cr 56/d �a.. /1 i G ) / /A. S 3 7/69 geed Restriction; CSM <br /> ` <br /> ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AID DRESS <br /> (iP0$ .; -632 3 ffil Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION - ' and includes dimensi ns <br /> AG ME CONTRA TOR NAME <br /> (%//rte 041wT7 _ /_EG e EX2- �=U S Si e Plan • 'ding location <br /> AG NT ADDRESS CONTRA TORIADDRESS • septic <br /> `-//7 -7Z/2.7.77-v4( Do. lab*-------... ._S(City,State,Zip) (City,Stat- Zip) Setbacks <br /> (` nJ me Jitez a,vD , T 5-356:'s_ " <br /> PHONE PHON l • Sit: Plan proval fr m <br /> (4,og l E3 g' -.3/0 a,,pli le town p. <br /> E-MAILADDRESS E-MAIL•'DRESS <br /> (I •loor pl s to scale <br /> PROPERTY/LOCATION INFORMATION (httpelacaessdane.co.dane:wi.'us/) <br /> "'a, Elevation of property <br /> PARENT PARCEL NUMBER: URREN ZON G: ACREAGE. <br /> 0 PARCEL 0/0 -/(y1(�„� c / i ,.I , 7 frontage drawn to ale. <br /> NUMBER `(�' <br /> TOWNSHIP: 1 SECTI : <br /> © C),I,v( t rA (, .C6\f l r ,/4: s.E. ,/4,/: s IN Driveway rmits <br /> �7 (state, ounty,to , <br /> ADDRESS: 416C11 91 S P A i'S o vn (� <br /> �`J► <br /> r • Sanita .-Traits <br /> CSM: LOT SUBDIVI IN BLOCK/LOT <br /> R G\ (l t ^\ .] 0) (pu• <br /> )i , private) <br /> , <br /> PROPOSED PROJECT INFORMATION <br /> �- �� i Tl RE I ili, <br /> � 'PROJECT DESCRIPTION: e Sk p y,i " 1 � ' <br /> - as-- - _ L e/ -1♦ • • •iiif g D �Y ; <br /> . ❑This project is a new building or structure. ;� > ° �: `--` - <br /> ❑This projec s an addi; /alteration o an existin• building or strucure. = b 3a�,�.- <br /> SANITARY SE' s_ % Ca' UMBER: el a ,_-%,_; Ia-r °°1: � ' <br /> .V%,;;* �- PTIC N 0 k� . <br /> HEIGHT IN FEET: NUMBER OF STORIIS: (Not including basement) a 34-,',.:: . mo t '-� <br /> etariaft60 . <br /> ., .taoze a , <br /> AREA TO NEAREST SQUA'E FOOT: ,� 7 '7-i <br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) -Y OSI® •G; - ° ° .*rf . <br /> BASEMENT: 1ST FLOOR: <br /> ' / <br /> �y 3 ,l TOTAL SQUARE FOOTAGE: ,,, g."��-O°e o is e`�3e� ��- <br /> 2ND FLOOR: 3RD FLOOR: r c'' <br /> ESTIMATED CONSTRUCTION COST: o , �1' ` ®°ire 4 <br /> (Please round to nearest dollar) 0. —∎ '� --► $ •� n a� r "' <br /> 1. The property is within 300 feet of a stream or 1001 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the progeny? ❑Yes r N• 26on't know <br /> 3. Have you talked with the township about your prof:ct and are they in agreement? ❑Yes M "o . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 7I, N <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No 2Don't know <br /> 7. Is this to correcta violation? ❑Yes 0-No <br /> Q C APPLICATION MUST BE SIGNED <br /> V (Continue on Back) ■ -4 4 <br /> 545-112(4/06) <br />