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4 (05-: 5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com 1=2:=TEZ:=217 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OYi, NAME ��`Z/� <br /> /� J /416/6/4 /jc e c ❑Zonin St s;CUP; <br /> OJV/NER/ADDDDRREESS (Number Stree(t�Crty,State.Zip' .�/ la- �^ tf" Deed friction:CSM <br /> /0/7 -/ 61 i /7 Jieckta�/`7►L J7J 7J Varian e(# ) <br /> HOME PHONE i CELL PHONE 1E-MAIL ADDRESS <br /> I C 1 ❑Site Plan ra to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME 1 � /� ON CT R NAM.% <br /> �Q A �e e1CJ, in .i4, C I y/� 1 J� U/Jf A. ❑Site P n i uding location <br /> AGENT ADDRESS CONT: CT ADDRESS of well tic <br /> (C ttyy�State.Zip /` I(C■ty.Stte.7:p) ❑S peeks <br /> fiazurv•Lin/<. Gt):,7S-60 I% <br /> PHONE /� �J 'PHONE ❑Site Plan :.p .�i . •m <br /> 6 4 6>- 7 yY' (/f/.r I applicab t. sip. <br /> E-M.AL.ADDRESS 1 E-MAIL AD ESS <br /> 1.!!t C S/n G w 7f,g, , .. + ar"-- ❑Floor pl o scale <br /> PROPERTY/LOCATION l'dFORMATION (httpa/accessdane.co.dane.wi.usl) ❑Elevatio Of operty <br /> PARENT PA ti R URRmi.T ZONING: ACREAGE: <br /> ❑PARCEL 1 ZZZ— r 8, �[(_2 1,x70 frontag awn to scale. <br /> NUMBER I�(,t J U <br /> TOwNSHP• i SECT;ON : <br /> 1/4. i/41/4. ❑Drivewa per s <br /> ADDRESS (state.c u y town) <br /> ❑Sanitary permits <br /> CSW: I LOT i SUBDIVISION BLOCK LOT ,� <br /> (public, ') <br /> PROPOSED PROJECT INFORMATION . '— <br /> "REVIEW <br /> PROJECT DESCRIPTION: <br /> 62/' Q mot ' or i.e- !' L .e '0 Zo trice <br /> J � � <br /> This{ oject is a new building or structure. j Perrrti#t4AbUse <br /> ■i This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: I PERMIT NUMBER J Rural . 4 , ss <br /> i <br /> (EWER REPTIC (newte +) <br /> HEIGHT IN FEE � <br /> 0 i i NUMBER OF STORIES. lNot nciu ink basement) . <br /> Shor:.:117-1 t .E achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area.attached garages and above grade decks or porches) j E . .. , , permit <br /> BASEMENT: 1 1ST FLOOR � , <br /> A 0 <br /> j TOTAL SQUARE FOOTAGE: + -...-4 s , <br /> 2ND FLOOR./ 3RD FLOOR: i f fr + S). <br /> ?y� <br /> ! Rev survey <br /> ESTIMATED CONSTRUCTION COST: aand - c options. <br /> (Please round to nearest dollar) -0 -0. -0 $ 7,...d 0d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies giqo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to DJon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes laic) <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 'lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ <br /> 545-'12(4'6;1 <br />