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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION <br /> C TOMER TO PROVIDE <br /> A jrt.Wirefe NAME <br /> ACC" 5-r4-14).5-r4-14).) a- 0 ZICCVLpp <br /> - Zo g Status; CUP; <br /> •9VKdlRADDRESS (Number,Street,City,State,Zip) Died Restriction; CSM <br /> 7�7 C j4Ptfi�L view - M I+t�D '�� ,�r• Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS_ <br /> (OS"' 608'77o-9 14 51k+t .0.(4.-Inc -c o% ] ite Plan drawn to scale <br /> AVCn■ INFORMATION CONTRACTOR INFORMATION and includes dimpons <br /> AGE T N CONTRACTOR NAME l... <br /> Jn Mhn 4L- NEturA4e McW€' ❑Sitq`Plar,ifScudin <br /> g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of weUfeptic <br /> L1762 GAQITr.�. Illptu Rd 12527 GAM WAITE Ln- "'/, <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> A4 100 CkTCPJJ j (41 . S3 tom— MT P'. 4)1. 5 3el s; ; <br /> PHONE PHONE ❑Site,Plan approval from <br /> 06— 23S --5(Z3 applicae township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) Elevation of property-' <br /> PARENT PARCEL NUMBER: CURRENTZONIN ACREAGE: <br /> ❑PARCEL /�� _ O - ' S frontage drawn scale. <br /> NUMBER `Tlf �g I -` <br /> TOWNSHIP SECTION , h 1 , 1 ( <br /> 1� 1/4: / v /e/4: .v ..) ❑ Dfiveway.fiermits <br /> i ��C e-.1\01iA tate,,bounty,town) <br /> ADDRESS. / <br /> Sanitary permits <br /> CSM: \ 7, LOT SUBDIVISION BLOCK/LOT <br /> t (• blic, private) <br /> PROPOSED PROJECT INFORMATION : AFF REVIEW <br /> PROJECT DESCRIPTION. / r <br /> _Sr S \i�, s�" 1t7 District <br /> lJ , <br /> . ❑This project is a new building or structure. ermined Use`? <br /> ❑This project is an addition/ Iteration to an existing building.pr ructure. <br /> SANITARY SERVICE: PERMIT NUMBER i Q Rurat/4dtlress <br /> FIEWER EPTIC / " Rural Address <br /> HEIGHT IN FEET r,; 1 NUMBER OF STORIES: of including basement) <br /> ��? i L We and/F'ioodpfarn! ! 7 <br /> Shoreiard (attachmen <br /> AREA TO NEAREST SQUARE FOOT: L1, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 1 <br /> BASEMENT. 1ST FLOOR: 0 trosionu ntr permit ! "C) <br /> S (•` 0 j TOTAL SQUARE FOOTAGE: ,, slopes,- isturbance,v ���JJJ MMM filli g/acceaa) <br /> 2ND FLOOR 3RD FLOOR / f / 1 , <br /> J v © Review Location Survey I I <br /> ESTIMATED CONSTRUCTION COST: J ��� and available options. V Cf <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ --► / <br /> i • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves mNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves mNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? OYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies mNo <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 No ❑Don't know <br /> 7. Is this to correct a violation? Dies No <br /> `tom /`\ APPLICATION MUST BE SIGNED <br /> I (Continue on Back) -♦ ♦ —► <br /> 545-112(4/08) (00)'` <br />