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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION Cu..TOMER TO PROVIDE <br /> OWNER NAME <br /> - b v1)/ Cr C0 D k _ 1 Zoning Status;CUP; <br /> OWNER ADDRESS (Number/ eet Ci ,State,zip) y/� _ z ed Restriction; CSM <br /> ?7g v hrS.0n /r�� �((-le'"? 4 -55 7�- ariance(# ) <br /> OME• ONE • L PHONE E-MAIL ADDRESS <br /> r t •OS .S- 'I I ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION : . .- nd includes dimensions <br /> AGENT NA CONTRACTOR NAME , i ) <br /> /S o/i n �ma /t 7 1u i lc el i Fl 1 Site Plan including location <br /> AGENT ADDRESS CONT CTORADD ESS of well/septic <br /> VD ivXg�7 <br /> (City,State,Zip) (City,State,Zip) , <^ Setbacks <br /> 6ro0�'y� W 53521 • <br /> PHONE PHONE / ❑ it Plan ynpproval from <br /> 610,- ./Vi"-6.77a2 � is 1e town hip. <br /> E-MAILADDRESS E-MAIL••DRESS / / l <br /> - • a r c ® i 7L e/ham door pia to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danicwi.usn NJ/Elevation of property <br /> PARENT PARCEL NUMBER::�� 9010 CUrRRENTZ IN ^ ACREAGE frontage draw scale. <br /> El PARCEL NUMBER <br /> © . '© V11 YJ , S <br /> TOWNSHIP: SECT ON: <br /> . , v (\10'\ < /0' V v/4: 4rivewyrmits <br /> 1/4: �\►" ' stat ,county, <br /> town) <br /> ADDRESS: <br /> LI 0I Y1 S nek vR v C'., Sanitary . r <br /> CSM: Li q LOT a SUBDIVISION BLOCK/LOT (pi Ili , •rivate) <br /> PROPOSED PROJECT INFORMATION ",N s <br /> i--TAFF RE1jI <br /> PROJVCTDESCRIPTION: fN - `' �W� L" <br /> >0 X 3o a�'���_ �' -- a I . ,an mg a soy a �3z,.- <br /> 5 can eY�fldl �` <br /> This project i a e Is • or structure. 1 3- <br /> ❑This project is an addition/alteration to an existing building or structure. ,. a _ <br /> PERMIT NUMBER: 1 ;` * <br /> SANITARY SERVICE: I <br /> �SEWER ❑SEPTIC �� x x 1- « %."t-%'-i,s <br /> -.€,,,�" ;.as s- =..� °z-' <br /> HEIGHT IN FEET / NUMBER OF/TORIES: (Not incIu g basement) l k.-, �. <br /> '(�/ , etaneiAnd• a <br /> ''1 ..hor 1 i •attac"hrnent) -, <br /> AREA TO NEAREST SQUARE FOOT: �, - , <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) KK� "r�s>I®., oA o,"o <br /> BASEMENT: 1ST FLOOR: / . ' •e `-.. <br /> ) <br /> 4. TOTAL SQUARE FOOTAGE: � . <br /> 2ND FLOOR: 3RD FLOOR: r— r c` s <br /> / - £1 <br /> ESTIMATED CONSTRUCTION COST: / D D s o a �lc71" m o ` <br /> —. —► —. S ,.l 0 00 <br /> (Please round to nearest dollar) Si <br /> i:' <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ 10 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Po ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El Yes ❑No " <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 2' <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none, <br /> 6. Is a location survey required? (see reverse) ❑Yes No `L P•n't know <br /> 7. Is this to correct a violation? ['Yes o <br /> At, 1 <br /> 0 <br /> cc,, APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► =-■ <br /> 545-112(4/08) <br />