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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 /> Coate' (-Cotta rl <br /> 1 oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> tghio to,/4hIrNitoll tt' Variance(# ) <br /> HOME PHONE L/ CELL PHONE E-MAIL ADDRESS <br /> (47O8) 8I- 081-n (1,06)17-0-10 8 I The holt rtfawtt L rAsil am e Plan drawn to scale <br /> AGENT'INFORMATION _ _. ' 4 <br /> ... ,.,a ,CONTRACTO�t 1!JFtRMgT10N i, -:;.,_ ' <br /> ;,; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 440lt)-11 81411A 1 ►.LG laidifiran including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> tt+3) W Sh Laotian- <br /> (City,State,Zip) (City,State,Zip) Li aSetb<c-ics <br /> Stottihton, tN 1- 5b58'i <br /> PHONE PH ORE/ ❑Site I approval from <br /> tOotb) 6cj6-©lo ap . ble township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> holtIt.vibul l le"uc B xMau-( tom or plans to scale; n <br /> `PROPERTY/LOCATION,INFORIOATIONT�`(http/%accessdane co,rdantz.vp).us/) evation of property'��� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: AC AGE: <br /> O PARCEL C6//- � sq QI/t-a ZL/ sF , 11 frontage drawn to scale. U <br /> NUMBER //�' ` <br /> TOWNSHIP: - S N; phi <br /> te46 4-- co(h'Miss S '/a: s ��A: t� Dr ay permits <br /> ADDRESS: U state, county, town) <br /> •l )wahtrt∎itvn Rk. ❑Sanitary .- 04, 4 <br /> CSM: C-7)--G LOT / SUBDNISI•• BLOCK/LOT , <br /> PROPOSED PROJECT INFORMATION '. := <br /> PROJECT DESCRIPTION: _ h ,r• <br /> Rc GarlSt'ru.ot' 11 toy(I t cA ro d S F onin DIs,Irictf ' <br /> 4" gi, -tip' { <br /> EjThis project is a newuilding or structure. _ ; 5 <br /> � mltted LJsM '. <br /> Ill This project is an addition/alteration to an existing building or structure. - <br /> SANITARY SERVICE: PERMIT NUMB al:A k1r- s <br /> r J T l` I A " t <br /> FIEWER PEPTIC C'/S 6`.'r Q / :g ' n�� r12 / 3 �6 <br /> HEIGHT IN FE NUMBER OF ORIES: (Not including basement) '� - <br /> �. 7 E °/ -a°�J_altl/� <br /> ��s <br /> AREA TO NEAREST SQUARE FOOT: irS °e —° ttaclimetlt) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t <br /> BASEMENT: :. . • 1ST F O 1 I - �Cp -° ° r�5pert�- - <br /> t kl - ��L) ,, TOTAL SQUARE FOOTAGE j i`r 5 6}32 a rtat1Cam x k <br /> 2ND FLOOR: 3RD FLOOR: �� �L n - eS- `k"2`§ g5 <br /> t � J� 6'�' Y € _ , <br /> ESTIMATED CONSTRUCTION COST: 1 �l�Revi o y tin Sti:F <br /> (Please round to nearest dollar) "� "� "� ♦ "/�J (� rd i7 �ptton :;',44:::,A:::F <br /> /V0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes [No • . Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes fNo [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 ENO <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? [Yes [No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0- —0 —0- <br /> 545-112(4/oB) <br />