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- 57C SO <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 'E � i--Amek 0 Loki no Zoning Statu UP; <br /> OWNER ADDRESSAumber,StreCity,State,Zip) Deed R ICtion; CSM <br /> Ut Ili t"�kk.0 1.\Sv,1. 360S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6°53 A31)-.,352 bur,-‘ - , }' 3' @ RCA-Co El Site Plan draverto scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAM <br /> 64Z-NrNn C5 k- a,--) k\t, `e 5 LL L © Site Plan includin o a ' n <br /> AGENT ADDRESS '/) CONTRACTOR DDRESS of well/septic <br /> W 32-3cb� � / <br /> t)rtL000ll 4vt..( �--� . <br /> (Ci ,State,Zip) (� �O (City,State, • Q Setbak( <br /> v t w L 3 \ v�jc <br /> PHONE ONE iii Site PI va rom <br /> O�— �� _ S3 applic t hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> t✓� (Q2'3o e • vrc ,\.to'.-, E]Floor pla s scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ©Elevationroperty <br /> PARENT PARC R: CURRENT ZONING: ACRE f�� nt <br /> ❑PARCEL Ms 66155-0 t' %O'7'L(�l •� f) frontage yawn to scale. <br /> NUMBER !� r[ tJ M�/� o�'�' <br /> TOWNSHIP SECTION: <br /> O '/4: '/a'/4: ❑Drivew per s <br /> ADDRESS: 5,4/` 1 III ^ , (state,c town) <br /> �✓1 t- r ©Sanitary permits <br /> CSM: Li�_/{/'1 A LOT t SUBDIVISION BLOCK/LOT <br /> `(] (public,private) (, <br /> PROPOSED PROJECT INFORMATION '° 1 1 Evil <br /> PROJECT DESCRI TION: <br /> �Wr✓`Sl stnet <br /> . This project is a new building or structure. Q Per Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ©'Karat Address <br /> EWER nEPTIC % tr/extsttrlg) <br /> HEIGHT IN FEET: \�y JMBER OF STORIS: (Not including basement) <br /> S .'- ....I- .tt tment) <br /> AREA T EAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: / 1ST FLOOR: / ro31t3nCOntrf�perm it <br /> '9. 5 \/ 3�3° �/ + TOTAL SQUARE FOOTAGE: ,+, (slopes,disturbanc , .alp <br /> 1 / f#ling/ rtes) ©��..k� <br /> 2ND FLOOR: 3RD FLOOR: n ' <br /> Re ,l,�q'$r.' ey <br /> ESTIMATED CONSTRUCTION COST: O( G� and - „ ' <br /> (Please round to nearest dollar) ♦ ♦ _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes c to QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ajo JDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? pk,es a'Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? MI es ej521Vo <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? Dyes to <br /> APPLICATION MUST BE SIGNED <br /> 545-112 laiosl (Continue on Back) ■ ■ -* <br />