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ZONING PERMIT APPLICATION www.countyofdane.colll SUPPLEMENT to Web Apq#` <br /> PROPERTY;OWNER INFORMATION . ., Y ,_ - .iM; CUSTOMER TO PROVIDE <br /> OWNM NAME <br /> iii-'-L/ 'r�GL-f'YI 4A-} Ch Zoning Status; CUP; <br /> OWNER ADDRESS umber,Street,City,State,Zip) <br /> ,T eed Restriction; CSM <br /> a77( t 4 !2✓e- /��5(e1835 g/14") lj).---C)'f✓P4ic ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> fig-27`/"3385 S. e Plan drawn to scale <br /> �AGENT!INFORNIATIO�1 . . „' ,CONTRACTOR-INFORM TION �`,- • cludes dimensions <br /> AGENTT AME CONTRACTOR NAME <br /> c�oT7 / Ge.,Z, 24=G'r/1157-R-G/G772 -) . e Plan including location <br /> AGENT ADDRESS Co T ACTOR DDRESS /�/� o well/septic <br /> - `�7 gre e "5�y7 b�rC z i--C% <br /> (C State,zip) Cam 4.2< (City,State,Zip) 6% >'t' /I / etbacks <br /> PHONE PHONE ❑ e PI approval from <br /> 02f s- v ., 6,4f-SZ�4g33 pp. able township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> 7 &p,-- -/g/ ■ � - - a 7— . , 6/z F oor plans to scale <br /> PROPERTY/LOCATION,INFORMATION -(httpe//aecessdane co.dane'wi us/) . levation of ro e <br /> PARENT PARCEL UMBER: CURRENT ZO ING: ACREAG : p p <br /> ❑NUMBER PARCEL 'ek I 1 .-.�aS„,9s6'© _© a frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> S <br /> jv,v a� 32 '/: 5, &'//4: <br /> ❑ Drivewa ermits <br /> ADDRESS: (state ounty 2wn) <br /> Z--776, • �v,e_- `e,- ❑Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ,6g (pub' , private) <br /> PROPOSED PROJECT INFORMATION - TAFr REVi_EW <br /> PROJECT DESCRIPTION: c . t. a ` <br /> - � A` i <br /> 50/X "l- 2l'nmc,�Dlsl:r�cti"e <br /> . EfThis project is a new building or structure. © ermltt e• st�� <br /> ['This project is an addition/ eration to an existing building or structure gTi } 3 L <br /> SANITARY SERVICE: PERMIT NUMBER: L� R1J-at 'ddres5 <br /> �_ 'ti * M1cG�.5 2 <br /> [EWER EPTIC f v .� ;.0-.1 Tlewrt t) • 4y r <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) • t r �i. ;” <br /> . .0?1 Ok. -Cloy4tramitoprotorig <br /> Z <br /> sfigi attacr ept) <br /> AREA TO NEAREST SQUARE FOOT: j 4 µa' ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) t =. 6' <br /> ;-�/ ��- 69.06'7;6366 g pertTilt; -_; <br /> BASEMENT: . - 1ST FLOOR: � �=` 'a S e`aba iri <br /> & 1 TOTAL SQUARE FOOTAGE ,j, • ,!3 1�., F <br /> -'� to cesa' '� <br /> 2ND FLOOR: 3RD FLOOR: : x ,z3 „' <br /> �kia, C� t aie {Lo atltn Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ i a �t able rani £ <br /> (Please round to nearest dollar) 1�f 5Co/ .�,,,5.-g.� 1u' - <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? [Yes No .❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es LJNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ye ONO <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (le a blank if none) <br /> 6. Is a location survey required? (see reverse) es ❑No a Don't know <br /> 7. Is this to correct a violation? Dies ZNo <br /> • <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► 9 <br /> 545-142(4/08) • <br />