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=sUPLEMENT o WebApp#ZONING PERMIT APPLICATION countyofdane.com <br /> PROPERTY`OWNER,INFORMATION VAM1 a t:,- . ,._4;, , 1,-;, _a CUSTOMER TO PROVIDE <br /> O ER NAME <br /> (-(X71 Xi.) -t-- K 1--'�_ . n Zoning Status; CUP; <br /> OgWNERADDDRESSumber,Street,C' , tate,Zip) 4>1 Deed Restriction CSM <br /> e E 6. O(T/enw A YELL HONE j — D l /y , 5.35 -/ Variance(# _ _ ) <br /> E-MAIL ADDRESS <br /> 6' Y4 —`t' • n Site Plan drawn to scale <br /> AGENTTINFORM A_TIONI ` '0, 5r4 rCONTItACTOq;INFORIgT ON Y a and includes dimensions <br /> AGENT NAME / CONTR CIOOR NAME <br /> 0 1" /��KI ii- _a,„ ( I/)^Cw C_o ..�.-‘<_ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Sf of well/septic <br /> 7S Yo J 4 Al y70i re -Ij % <br /> (city,State,Zip) / . (City,State,Zip)/ 1 1 7 , [1 Setbacks <br /> PHONE • l( V PHONE ❑Site Plan approval from <br /> 7/5 _ g T,;, _ A 1 4 .y d o -q' 3? - es -207 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> TM 7$ •p G - 14•, a I ' 6 owe -h re, 1 (ap f v‘e w . C on-N ❑ Floor plans to scale <br /> °PROPERTY/LOCATION•INFO)tl)AATIIOMr`,.(httpa/accessilane.co.dane vin.us/) 3 _ ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER OY al e)SbY 3 Y1-9"75-8-° '\ i l-.7 ' �4G�, <br /> TOWNSHIP: - SECTION: <br /> ,/4: ,/4,/_ ❑Driveway permits <br /> re-q.u1'` (state, county, town) <br /> ADDRESS: J / /� / <br /> .2 O ` 'e n <\.y 1` a ❑Sanitary permits <br /> CsM: /6 g 41 LOT f / SUBDIVISION BLOCK/LOT (public, private) <br /> 0 <br /> PROPOSED PROJECT-INFORMATION -;; -1ST R vi �. <br /> PROJECT DESCRIPTION: ti. k <br /> Sic '-1 ° S 6 end .NC "': <br /> 1 <br /> • ❑This project is a new building or.structure. • -- ., F� � t' <br /> ermlfed 'sL <br /> This project is a additio Iteration to an existing building or structure. _ + fi <br /> �.� �-� -tee <br /> SANITARY SERVICE: PERMIT NUMBER: L $1 = yq9 a" �$ - �' <br /> (EWER 1. EPTIC ,k: W , 4- <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) F .< <br /> - S / E e_a '/P-odd e 11 7 <br /> s 110` aarfe `� 4- <br /> AREA TO NEAREST SQUARE FOOT r _„ }:. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) Y� "- ° <br /> BASEMENT: - 1ST FLOOR: <br /> 1 TOTAL SQUARE FOOTAGE: ,l, . :1,g.,.__:,,,..`_3` �b @ 2 <br /> 2ND FLOOR: 3RD FLOOR: �/ /� ,., 't '� ` <br /> • <br /> ESTIMATED CONSTRUCTION COST' ' -► 60 - d` e _ ,,s <br /> (Please round to nearest dollar) ♦ ''♦ '♦ ♦ $ l j 3 J si �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes rlo • ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes DM-) ❑Don'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'? s QNo <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 Drab - ❑Don't know <br /> 7. Is this to correct a violation? [Yes DTO _ <br /> • <br /> APPLICATION MUST BE SIGNED <br /> • (Continue on Back) —► —► —► <br /> 545-112{4/08) • - <br />