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Fsj— / — doao6 .- . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEME�JTtorWebAppL <br /> PROPERTY OWNER INFGRMA 1 N r}; r � `3'= , _ '^ v.^R:` <br /> __ . ,.., �_�.,..t_Q .z - ,.�fi E_ n �r.-s.-�._-�... ,x;gak ... CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> L, L e t /1 4 e -e— o v I' �e_ f 0 /-- : <br /> I 1 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Cjty,State,Zip) <br /> Deed Restriction; CSM <br /> 9r? /CoS gCOnorr D' Variance(# ) <br /> HOME PHONE CELL PHONE MAIL ADDRESS <br /> ?a 7/`7 F- 4 d'Cj° w Pffi,P/ I I Site Plan drawn to scale <br /> AGEIii r1NFOR�YIATlOjn1 CON AC,T,O;�t x,-40 qT ON - '- and includes dimensions <br /> t <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) I Setbacks <br /> PHONE PHONE I I Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> t _... -- •-S"7�3Yi�P.19aer1 - ^ atl�4 <br /> *ROP0.RTYILOCAT 0F. 1NFORIIAAPON?.; (httpa/fecess�ane O:01 .v 100 x _ <br /> PARENT PARCEL NUMBER: CURRENT NIN : ACREAGE: / I Elevation of property <br /> El NUMBER D6 a/q/Soo0? —1-e7L. 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> rI,-0.5o,,w1.. S e ,,,75/ /!f 1/4: . 4A: El Driveway permits <br /> ADDRESS: I J (state, county, town) <br /> IgS-, leecJ'16 " o Jet r.5 Di <br /> CSM: LOT SUBD ISION BLOCK/LOT ❑Sanitary permits <br /> (public private) • <br /> PROPOSED PROJECT INFORMATION ' vSTAFARErIE iy <br /> PROJECT DESCRIPTION e 'x rte <br /> on ng DsEneN: E t F <br /> ' ' 1 S <br /> ; g <br /> This project is a new building or structure. . <br /> p 1 9 3ermlfttd¢lJs9-1 <br /> ❑This project is an addition/alteration to an existing building or structure. l .A _ <br /> SANITARY SERVICE: PERMIT NUMBER: t till A�IC{r l p a - <br /> rpew elsl)t3� <br /> SEWER M1 yam- 0� <br /> HEIGHT IN FEET ( NUMBER OF STORIES: (Not including basement) A3 �;' 4 '°_ ' <br /> / itvAtlarp.ff oosiplalni Nt <br /> It�Shore1artd ttachme ) - <br /> AREA TO NEAREST SQUARE FOOT .;4 r 4 *^�'`� - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ' r .� <br /> Q ErDSIOn,C-orl (perC It <br /> BASEMENT: 1ST FLOOR: w g,T ;� A �_, <br /> (i`J /A�� j TOTAL SQUARE FOOTAGE ,j ` slopes -d skurtvi ,, ' <br /> 2ND FLOOR: 3RD FLOOR: -T?" a - oNF, s <br /> e l,T i�..ocatt n Spey <br /> i - <br /> ESTIMATED CONSTRUCTION COST: =� ti a egableapfions-i <br /> (Please round to nearest dollar) ♦ . ► ♦ ♦ -► F�op Y. jy ' k <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes [ No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes 1,1No [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes `INo • <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 E.No ❑Don't know <br /> 7. Is this to correct a violation? I fYes 2No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0 -> <br /> 545-112(4/08) • <br /> • <br />