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' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERM <br /> "ae ' •Ik Mull id f_ ❑Zoning St to ;CUP; <br /> OWNNERRADDRES (Number,St ett1City,St Zip) Deed Res ri tion; CSM <br /> 11 48()0 "`V�'L gA ; 5ton rre4 r�t 11 (JT Variance( ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> '•i .( -(t7o73 11 -7e A vtic i; owl ❑Site Plan yawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and ipc des dimensions <br /> AGENT NAME CONTR CTOR NAME <br /> ❑Site Plan ncluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel ptic <br /> (City,State,Zip) (City,State,Zip) ❑Setbas <br /> PHONE PHONE ❑Site Pl i f p'',‘val from <br /> appli b t• .hip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑Floor pla s o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elev i ly. •party <br /> PARENT PARCEL NUMBER: CURRE TZONING: ACREAGE: <br /> ❑PARCEL Oj1 311-82& - / R ' D,4+ 7 front • a n to scale. <br /> NUMBER -1 v�( V K <br /> TOWN IP: SECTION: ❑ <br /> �C,;C;Q 3 '/4: SE '/4%4: N E (state,co town) <br /> ADDRESS: <br /> '«') t7 LV;h 41 &t,r,Y( <br /> 4;(—c 1 1 5354() ❑Sanitary p- mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 6 50 . W (public, • Iva,-) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> ❑This project is a new building or structure. j <br /> This project is an addition/alteration to an existing building or structure. `E�4 • ' 21 r .' <br /> SANITARY SERVICE: 1:11M,17 <br /> PERMIT NUMBER: '' x g <br /> EWER PEPTIC x O� 'r'~'..--404 <br /> .� VA P �' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) a <br /> • (s t <br /> AREA TO NEAREST SQUARE FOOT: "` <br /> r <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) .'-3` , ? , -. <br /> BASEMENT: 1ST FLOOR: w •' ' � a4 <br /> /VIM 5F 4, TOTAL SQUARE FOOTAGE 4, S •; �t! , <br /> 2ND FLOOR: 3RD FLOOR: 1 <br /> agos�' ,, *4.1 yal <br /> ESTIMATED CONSTRUCTION COST: "; `�� ?-, 4 <br /> (Please round to nearest dollar) -, • $ 3 O6 - , .:.a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies I: Oo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ego ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes f o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies Elio <br /> 5. Is this project associated with a rezone/CUP/variarice(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies Digo ❑Don't know <br /> 7. Is this to correct a violation? Elves E c o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(4/08) <br />