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oSYP LIMBNT. o;**Aiiitt <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION "Y 1 ' - <br /> ,_,.__ iy 4• ..« CUSTOMER TO PROVIDE <br /> OWNER NA� �L— <br /> I Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - <br /> -C& "�'c q9 Variance(#fiction; CSM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C6IS- S2i3 c/g7( T .x � I Site Plan drawn to scale <br /> _ _ � �#� <br /> AGENT'INFORMATION .``, CONTRACTOR�INFORMATION ��, ��,.; ;; a n d includes d i m e n s i o n s <br /> AGENT NAME CONTRACTOR NAME r w. � v <br /> yam, �r� �- - _ Site Plan including location <br /> AGENT ADDRESS CONTRACTIRESS of well/septic <br /> n90;3- ,:s le_\r-0y-\Q-_ <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> ' ,r p U,\ Q-r 1--t-) ,S-S;Y(P <br /> PHONE PHONE I ( Site Plan approval from <br /> r <br /> (.I - - -j applicable township. <br /> E-MAILADDRESS E-MAIL AD SS <br /> . d Q J N LkC 0;� �� Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdan.e.co.dane.vvi..usaAMe <br /> , { x <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> 7 PARCEL �y -7 A �L frontage drawn to scale. <br /> NUMBER OGI( ?-4°gU / AA e 9 <br /> TOWNS SECTION: <br /> .pCts;e�\" `fit ,� SC-,) '/4: N 0 1/41/: I I Driveway permits <br /> ADDRESS: _�(�J'"`__ �-� r� ��� (state, county,town) <br /> 7 -4")425— �� _Se.3 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION • r zt STAF <br /> PROJECT D CRIPTION: �,_, 'i$' " A � ` <br /> /.CA..-5 'L fl Ommng 2,1S 1 c -:1' ,. <br /> 4. "v� <br /> . his project is a new building or structure. -� 1 '. <br /> n This project is an addition/alteration to an existing building or structure. :j= �} = � E: Vg <br /> SANITARY SERVICE: / PERMIT NUMBER: r� R Tales CS "' -oa <br /> ^SEWER ( ✓SEPTIC 13 -00/c`610 new exrs 1 01 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) t a �. T._ E. <br /> ' -- Wet1anl sods a i_if ° ., <br /> 5 reigns attachment)Y., <br /> AREA TO NEAREST SQUARE FOOT '' , - ._` <br /> (Outside dimensions including unfinished area, attar d garages and above grade decks or porches) e -- <br /> ® Eroston&"ontro nerm1 _;vim <br /> BASEMENT: 1ST FLOOR: 1 <br /> 15-(9' C 'r �s <br /> _ S/J�-`y/ , 7 s o p e'r� s d <br /> stranc TOTAL SQUARE FOOTAGE: 1 �� , <br /> t <br /> fillm_glaccess}_ - �=- 4 <br /> 2ND FLOOR: 3RD FLOOR:,70 ; � ' _ ;n^I/ ¢ <br /> ID tiRel1ft ocatron-Surve <br /> ESTIMATED CONSTRUCTION COST: c� ova a pfion '- <br /> (Please round to nearest dollar) -I0 -10 -0- -0- -0.- -0- // ' may J t <br /> a s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? n Yes o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nY s Rio n Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes n No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes nNo <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) nYes No Don't know <br /> 7. Is this to correct a violation? n Yes P/No <br /> ao(c v Yz ( APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -* -♦ <br /> 545-112(4/08) <br />