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ZONING PERMIT APPLICATION www.countyofdane.com :SUPPLEMENT to:Web App.#' <br /> PROPERTY;OWNER INFORMATION . ,_ _ . , r.'._ ;... r r' CU•TOMER TO PROVIDE <br /> OWNER NAME <br /> .,,,A 1 e1 I- fob) I C R ig-Zon. g Status; CUP; <br /> WNER ADDRESS (Number,Street,City,State,Zip) <br /> D d Restriction; CSM <br /> 1163 E$Ti47 [..n1 St-ovcth?oh O S�3S $'7 V riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (ee-7 S'7> 98y8 ,s olwa.c it Plan drawn to scale <br /> AGEN.T'INFORMATION ;CONTRACTOI(_t'INFORMATION_ ° ; a includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> it Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Of ell/septic <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE ❑ Si a Plan ap oval from <br /> a pli abl ownship. <br /> E-MAILADDRESS E-MAILADDRESS <br /> I r plans to scale <br /> PROPERTY/LOCATION,I_NFORMATION (httpa/accessdane co,dane:w,.us/) ' ' evation of ro e <br /> I <br /> PARENT PARCELNMBER: CU RENTZ ING: ACREAGE: p <br /> ❑ p <br /> NUMBER / r O7'_,3074, ^� rontage drawn Cale. <br /> TOWNSHIP: SECTIO7 h1 (� <br /> • �,I nkc �)(\ / IA: 1 '/a'/: N ❑ Dnvew permits <br /> (stat , county, town) <br /> ADDRESS: q03 ( ' Le, N CSM: LOT SUBDIVISION Ir' , BLOCK/LOT ❑Sanita •ermits <br /> ?le4sa,A�141 (I 1' • (p bf,, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW• <br /> PROJECT DESCRIPTION: ( / �g r ' <br /> R EAR .t oe sr'd D Ec K ��ottito 1 act ntimoarervinvmkt <br /> . RThis project is a new building or.structu re. Permitteda �� z t <br /> ---. 12 This project is an addition/alteration to an existing building or structur . r '�5 <br /> SANITARY SERVICE: PERMIT NUMBER: 0 RuXal d arryeS - <br /> 4s tiewl)gtin1a s ''7: ?. <br /> EWER [EPTIC / - � } <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) i; ' <br /> QiWetlalid/Fl;a•,Main!g ut i <br /> e f �iS �-S-... - <br /> Shorelas a�tattac .mept) <br /> AREA TO NEAREST SQUARE FOOT u 4 � j <br /> � � � � <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �. • �. <br /> BASEMENT: 1ST FLOOR: 70-86*75kl 1 a Rem it V { <br /> s <br /> TOTAL SQUARE FOOTAGE .`cps``t51 l bat' UT.0 C T i . `1- <br /> 2ND FLOOR: 3RD FLOOR: 44 <br /> 1z4111, <br /> wx c3 <br /> 0 Rena:. d abon Su 7 <br /> ESTIMATED CONSTRUCTION COST Sy0 d a>a a iez p ts,�r <br /> (Please round to nearest dollar) .■ !-). ""∎ "♦ "'∎ 0, D �L fir. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? L]Yes ONo ODon't.know <br /> 2. Is there a wetland or floodplain on or near the property? []Yes O/No [ 'Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? []Yes QNo <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? Des NO <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) Elves EN. ❑Don't know <br /> 7. Is this to correct a violation? Elves [v to l ' 0. G <br /> . APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ --1. —+ <br /> 545-112{4/08) 1 <br />