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ZONING PERMIT APPLICATION www.countyotdane.coi91 ;SUPP,LEMENT to Web•App# <br /> 1PROPERV OWNER"INFORMATION Via.°V i _ _ 2 _ ry1. _t_< _':AZ- CUSTOMER TO PROVIDE <br /> OWNER NAME pp <br /> Gtx-tJ P IC. c-%_ I 00 S n Zoning Status; CUP; <br /> OWNEFirADDRESS Nu ber,Street,City,State,Zip) I - Deed Restriction; CSM <br /> F1 LlP `( �,i -1.�. • -0� (� 0A- . l T Variance(# ) <br /> HOME PHONE CELL P"�NE E-MAILADDRESS V - <br /> I ; b% 1 435 '".A eZ cA)Z-lam O C.7-1.44 At LC. 111 Site Plan drawn to scale <br /> AGENt(INFORMATIO02:0"_ ate' ,_tirf -ICONTItACTORIINFOR IgT10N R:3_-{; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENTADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) . (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS - V <br /> ❑ Floor plans to scale <br /> PROPERTYILOCATION_INFORMATIONp :(http,//accessdaneco,dane:vin.us%)' _ s'e ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT-ZONING: ACREAGE: <br /> ❑PARCEL _ frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: - • SECTION: <br /> CaC cwt PC5._ /a. %/4. ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> tZ ( L J ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT-INFORMATION - - s SFRI: � H1 <br /> PROJECT DESCRIPTION: .' '- ; z ' 6 F' <br /> This project is a new building or-structure. —:-.,._T-,..4>A-- ---;r: <br /> '� <br /> ❑ P j 9 ,, ,- Iff-d' see C7 <br /> ❑This project is an addition/alteration to an existing building or structure. r_r <br /> SANITARY SERVICE: PERMIT NUMBER:' e F: <br /> k_«r E <br /> EWER . [)EPTIC E< a %. �' -/ <br /> ��a <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) . <br /> tt. • 0 ee 113 <br /> Q aid<w °� <br /> AREA TO NEAREST SQUARE FOOT ;; <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) 'tmi'''_ <br /> BASEMENT , 1ST FLOOR: r <br /> 4. TOTAL SQUARE FOOTAGE .4, 5C7og u <br /> r ` <br /> 2ND FLOOR: 3RD FLOOR: <br /> . Ca.- ".� .- �` -._7„x+-.. <br /> . r rit <br /> _ • <m a evi I-Z- e[a - Y-9= <br /> ESTIMATED CONSTRUCTION COST: i • F E• Q ` <br /> (Please round to nearest dollar) ♦ ''•'r ♦ -- -4* --► _ <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? ❑1'es ❑No .❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Dies ❑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 END. V ❑Don't know <br /> 7. Is this to correct a violation? [Iles ❑No . <br /> • <br /> • APPLICATION MUST BE SIGNED <br /> (Continue on Back) -9. -.• -* <br /> 545-112{4roe) <br />