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ZONING. PERMIT APPLICATION www.countyofdane.com =SUPPLEMENT to Web Appy# <br /> - �W t - �_ X l t Yt1v <br /> PROPERTY,OWNER"INFOR 11-010 ,1 . ��t� ei f `r} e t�, n3,a CUSTOMER TO PROVIDE <br /> OWNEVAMME / <br /> /"llc Pat,I 6 u Zoning Status; CUP; K �I / <br /> OWNER ADDRESS (Number,Street,City, late,Zip) Deed Restriction; CSM 71 `1 <br /> l ) 16W-di Kami_ 6tixj _ Go—, L4 53_ScZ7 Variance(# ) <br /> HOME PHONE ELL PHONE E-M 1AILADDRESS <br /> (o9s G Jlak_rn' /9 if f gl Avd, LO'"' ►a Site Plan drawn to scale <br /> AGIENTIINFORKATIONIV*.OMMA rOliktitilffikliWirRigtroilMEMV7 and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location' <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic �/ ___________/- <br /> (City,State,Zip) (City,State,Zip) Setbacks - ��/Z5-e�� <br /> PHONE PHONE Site Plan approval from ,j <br /> applicable township. P74 <br /> E-MAILADDRESS E-MAILADDRESS . <br /> kjFloor plans to scale <br /> PROPERTY/LOCATION1000,tl)A41:011. (1 tPalac lii0ne.CO,dane.v Mig/P p Elevation of property <br /> PARENT PARCE L NUMBER: CURB IT ZONING. ACREAGE: <br /> NUMBER 17// -o33-09g- �Z PT —/ _ , � 3 � frontage drawn to scale. <br /> TOWNSHIP: SEC I . / <br /> p {� '/a: s '/4'/4: A Driveway permits <br /> ADDRESS: (state, county, Olt <br /> e <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3 i e o (public,, permits <br /> , .ili� <br /> aq•s r- s .;-_ <br /> PROPOSED PROJECT.INFORMATION � STAPIPRf\TIg1 l ;■PROJECT DE Jt1PTioN: I r - <br /> [This project is a new building or structure. g F °. <br /> a - laed s <br /> This project is an addition/alteration to an existing building or structure. tca <br /> SANITARY SERVICE PERMIT NUMBER: 4L Al e-- t <br /> . EWER (EPTIC "0 ` `fit 7-x,- <br /> V '� <br /> HEIGHT IN FEET /`V NUMBER OF STORIES: (Not including basement) �t4 <br /> / ',-, E 13DM0ceoldltl �. <br /> . ► 1!a 6tac,e�1t. i4- <br /> AREATO NEAREST SQUARE FOOT to - ' ''-f" <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) : >':.� _`.'� - f -. <br /> P_...1 o e eil e ert = <br /> BASEMENT . 1ST FLOOR: \ a B 9 � <br /> L ' j, TOTAL SQUARE FOOTAGE 1 _ <br /> '-'mo o G 5 - t <br /> 2ND FLOOR: 3RD FLOOR: l —r" s k-_ �t /. <br /> E.9 tevie a_a era _ <br /> ESTIMATED CONSTRUCTION COST: a ,-1 1a` e c e-; S{ <br /> (Please round to nearest dollar) ♦ ♦ ♦ • "� �-000 - - ._ -- ~� <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' [No.' Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes [No .[Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes [No. . . _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years'? [Yes [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 [No ❑Don't know <br /> 7. Is this to correct a violation? [Yes [No . <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —► —► <br /> 545-192{4/08) . - <br />