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✓' f O SUPPLEMENTrt W.-_.,`A. <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY;OWNER INFORMATION ; . : . .;$'`, _ t33 --,.,. CUSTOMER TO PROVIDE <br /> ""�/�R NAME •• Piy► <br /> Er IQ/A (JG v y(o ("Ye' 7 ❑Zoning Status. P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ Deed R tr. ion; CSM <br /> ,cyul /(4 ESE XCT c(7- Y7' kAv/VA, .' ',1 i g P 4' I Variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> 50• ' :7-1Z-7Z ` ❑ Site Plan ra to scale <br /> AGENTIINFORMATI" ∎ ::-::?:"..":'..'::i.:-...::..'• CoNTRACTO�t_INFORMATION+ 4,; and inclu dimensions <br /> •NAME 6 -e-y CONTRACTOR NAME <br /> et 47 Mob,_( L LM-c---"J >' `/L L , ❑Site Plan inclludi location <br /> ABENTADDRESS 99.NTktACTOR ADDRESS of well/sept{w <br /> L+- 1 Ku t 4 5� f Z-+- i f I. r <br /> (City,State,Zip) (City,State,Zip) ❑ Setbo <br /> W a,l,t � k,i\ s3 5 c 7 <br /> PHONE PHONE ❑ Site Pla .45(•4•- from <br /> - applica, - ,•1 n hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • ❑ Floor plans fb scale <br /> ' R?.'<.. .. L= TI' I- 7.7111 _ T '• - - ,_ ❑ VV <br /> Elevation o ro e <br /> PARENT PARCEL UM R. CURRENT ONING: ACREAGE: p <br /> 0 NUMBER 9 bOCo 02 a'" ' -7, S frontage awn to scale. <br /> TOWNSHIP: � I SECTION: <br /> 9 p V / `c ,�: '/a�/a: [' Driveway p Its <br /> ADDRESS: (state, c nty, town) <br /> 5441 � I,S�y Gf- . L6 � K � VJ,w, Imo. <br /> CSM: LOT SUBDIVISION BLOCK/LOT !'3cj"f�❑Sanitary per ' s <br /> (public, pr <br /> PROPOSED PROJECT INFORMATION •.. STAFREVIEi111 <br /> PROJECT DESCRIPTION: } 0 ` N - <br /> • ['This project is a new building or structure. {❑ lefmltt o Uses <br /> ❑This project is an addition/alteration to an existing building or structure. f mat s :=Ry° <br /> ❑�Rura�;Addj sN <br /> SANITARY SERVICE: PERMIT NUMBER: ? <br /> EWER PEPTIC S t a c , <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) a z =$t <br /> f Shaelany- `mef;t) - <br /> AREATO NEAREST SQUARE FOOT: - J Y1- <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t <br /> ty E[iD1on e" •i •e 71t <br /> BASEMENT , 1ST FLOOR:, • _ { r-,�-�--=_. t <br /> j TOTAL SQUARE FOOTAGE J. : p '-;�y A° C ,��-,5} <br /> • <br /> C <br /> 2ND FLOOR: 3RD FLOOR: / /n <br /> ❑. . <br /> ESTIMATED CONSTRUCTION COST: � aR.c., r �6p O.11, 4„ -` <br /> (Please round to nearest dollar) ♦ "� ♦ ♦ `-7 7_ z__ 16- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Iles. ❑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 ONO <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) Elves ENo ❑Don't know <br /> 7. Is this to correct a violation? Oyes ❑No . <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -♦ <br /> 545-112{4/08) <br />