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ZONING PERMIT APPLICATION www.countyofdane.com ::SUPPLEMENT to Web App;# <br /> PROPERTY OWNER:INFORMATION , -; . __:, : , .,._.;. .- .: CU .TOMER TO PROVIDE <br /> OWNER NAME <br /> Wetyll-e /' . it/e.W ele a Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,6ty,State,Zip) eed Restriction; CSM <br /> 7el/4 S ',/7ePeer -i'r� 7V;e40//404 t/,. .53- - ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60ef-fY/-o5-.3C X08--s2 - )'/?5 .te Plan drawn to scale <br /> 4AGENTtINFORMATIOjN . ,,.;V `CONTRACTOR INFORMATION tn sf nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> eirig to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f f well/septic <br /> i <br /> (City,State,Zip) (City,State,Zip) in Setbacks <br /> i'v,eievoie.e. <br /> PHONE PHONE El ' Plan a oval from <br /> 6. re'- o?o( - i 2 f7 app. a township. <br /> E-MAILADORESS E-MAIL ADDRESS <br /> F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION `°(http Ilaccessdane co.dan.n,vpi.us/) '. <br /> PARENT PAR EL/ MBE`R�: 2 CUR ENTZ ING: ACREA99 levation of property <br /> NUMBER O ©v^ " / ,�o © ,; � j rontage drawn to scale. <br /> TOWNSHIP: 0 SECTION: <br /> 3 ,/: � ,/4,/4: ki ❑ Drivew ermits <br /> � SS: fl . /, (sta , county, town) <br /> AD ESS: . <br /> 7�VC Ssehr,iefe, 4? /ifl c"c/77 lion VV/ . �‘••, ❑Sanitary p its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> public rivate) <br /> PROPOSED PROJECT::INFORMATION - = STAFF'rREVIEW <br /> PROJECT DESCRIPTION: t t , <br /> D \e 1'� '' 1 VV onlrlg District� <br /> . This project is a new building or structure. i! °ermifted,-Uses <br /> This project is an additio alteration to an existing building or tr ct e. <br /> C# RuHt .•re 3 <br /> • <br /> SANITARY SERVICE: PERMIT NUMBER: �=___�, � <br /> r)EWER 'W EPTIC F -�newf$04166.):'' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) s "` <br /> I Wetla o o aln/ <br /> Shoff 1a 5- attachme t) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions includiq�q unfinished area attached arages and above grade decks or porches) 6` -, :- � Y { <br /> Q �roslopCo'ntr.o rrnit <br /> BASEMENT . * 191 FLOOR: 3 ] > p ' z <br /> © 4, TOTAL SQUARE FOOTAGE 4 a` slopes this •apse, e <br /> 2ND FLOOR: 3RD FLOOR: /� :ate ,„4 : ;3 ,� _ e5 <br /> i <br /> 0 RevieWsLocation Surve' _ <br /> ESTIMATED CONSTRUCTION COST: - O Yr' j <br /> (� r acrd as teuptrons, <br /> (Please round to nearest dollar) '� ♦ ♦ Q) v r 3 ��.; _° _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Y s o • ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N• <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal#_ ) (leave blank ' one) <br /> 6. Is a location survey required? (`see reverse) ['Yes 0'40 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes tgNo • <br /> ,..7 t?.....N , <br /> cO I <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112{4109) <br />