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` $ SAV.MENTr tO itOis `rt <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CCI Q_. k. <br /> I I Zoning Status. UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed R stri tlOn; CSM <br /> 1351 --P1\ s -oC Variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (.4()S S'3( -D 10 (00� ` locl- g S 5ci OevkAvt%.-1A (tr rci`• mci,a CL y\ Site Plan drawn o scale <br /> AGENT INFORMATION: CONTRACTORP1NFORMATRIN1 -II,,-P,;, and includes i ensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1 Site P an i luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well , tic <br /> (City,State,Zip) (City,State,Zip) I I Setba�t�,8/ <br /> PHONE PHONE I I Site Play a•or I from <br /> applica'A :to ip. <br /> E-MAILADDRESS E-MAILADDRESS / <br /> . I I Floor play scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdanecodanewi'usl),za;� „�A ,�., ElevationVVV pr erty <br /> PARCEL NUMBER: CURRENT ZONING: ACREAGE P y <br /> r7PARCEL o p% a\- -8Soo - 0 A-1 -x L40 frontage dra n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> \. 1/4: 1/1/4: I Drivew.y •-,J S <br /> ADDRESS: (state, •. t ,town) <br /> n Sanitary perm its ., J <br /> GSM: LOT SUBDIVISION BLOCK/LOT (public, p U ]u <br /> PROPOSED PROJECT INFORMATION . -. (STAFF 'E\/.IEVY <br /> PROJECT DESCRIPTION <br /> x "O�Cr0QQ) 11 r�ICtl CY` C . <br /> U This project is a new building or structure. k ,s - . ;' <br /> -'. er =-. Uses -!.,.x :,. <br /> 11 This project is an addition/alteration to an existing building or structure. 6...4'1,-5; . ,,; ��i -� <br /> SANITARY SERVICE: PERMIT NUMBER: R¢4 rah m• S z <br /> M.k"" ' '''''V4'''._:- <br /> TISEWER InSEPTIC , new e' ° ` <br /> ;;;:ii r4 i - , <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) "� - r ��" �''' t_. <br /> �\ i .vt �t "etlan e,4� ® a �ZSA. <br /> � 51a o s-me )�, <br /> AREA TO NEAREST SQUARE FOOT: s' e °" �{ <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) - :..,, 4.. ` <br /> BASEMENT: 1ST FLOOR: —°� ETOSIO a ,s re pert " " �, I <br /> '2) Li-L1-4 4, TOTAL SQUARE FOOTAGE: j, �(S O• ce `t �.nC. <br /> 2ND FLOOR: 3RD FLOOR: fi y+ttS � f: <br /> Revs i.; ,: -Serve - <br /> ESTIMATED CONSTRUCTION COST: a. o;$ on <br /> Please round to nearest dollar "♦ "� "♦ ♦ ♦ ♦ $ .�t 000 , 00 - pfi —,. ri t <br /> ,s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes In No _Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes La No ❑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? Ell Yes kv,61 No <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) (Yes [2:1 No 0 Don't know <br /> 7. Is this to correct a violation? 0 Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -► —* <br /> 545-112(4/08) <br />