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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> IMO If-e6 TQv2IS Wing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 12-l[ct hltn ) Sec '4 (05\ Fk y ion VA- -2_01 Variance(# ) <br /> HOME PHONE CELL ONE E-MAIL ADDRESS <br /> e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION � I and includes dimensions <br /> AGENT NAME CONTRA TOR NAME a'Ve IC f men LEy I A ., <br /> wy ICS P'.' tall ' • I /, ow iv Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRE•S of septic <br /> frO q-EnIrtiM V'(-t • 40-)0 4;51 i q V):t NI 12d <br /> ,,,0�S�t(atte�Zip �/S (City,State, ip) ! Setbacks <br /> r,IN""��� ' "—i � � jue- N,CU S� I ) ❑Site n proval from <br /> (DO ) 4?)-1 (-0I9)( (fit) -1 691 lam v( ap li township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> , jch 0 ,C(eve!'t►1Yie .GDYYI ® I r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: <br /> CURRENT ZONING: ACREAGE: <br /> V E ev Ion of property <br /> ❑ J l /O G 2 - 15 fr ntage drawn to scale. <br /> le. <br /> NUMBER 0101-252—%10 <br /> TOWNSHIP: SECTION: <br /> �S IU 1� 25 /4: Y v %,A: N <br /> ( ive y count,,permit_ <br /> ADDRESS: ` ( [� COUnt,, own <br /> I 3 J me(C� T bi []Sanitary its <br /> CSM.I �, 1 LOT SUBDIVISION BLOCK/LOT (public rivate) �� <br /> PROPOSED PROJECT INFORMATION aMfl 6/ <br /> PROJECT DESCRIPTInN• /�ra <br /> l e •• I <br /> i. 0 Ix ii ♦ �`J (ken , 77-a--.--4,i,----.--i-,..;„,,,'"�i t i / .iry District <br /> J <br /> . <br /> This project is a new building or structure. Ill, ,, -.'0'10 '' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 11 '1 . AEtdISSS <br /> EWER AIEPTIC 19)—211 CP — 000 o4 triiiii0 Kong) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimen qns including unfinished area,attached garages and above grade decks or porches) li - p <br /> •,a <br /> BASEMENT: In i '1 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4 S"* *,, i..:1'..... t t:.. <br /> 2ND FLOOR: 9RD ILOGR: &ay 01-e ���� on + <br /> I CEO �IZ : ' : Location Surrey L! c.�o, <br /> ESTIMATED CONSTRUCTION COST: tj,�U9' fi n <br /> (Please round to nearest dollar) --► -∎ M Jc D JW� C f r01� <br /> eUVa -. loU,� 7Q i l/O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Do ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Res Olo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es 010 <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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />