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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> K)t a- .k Nio}NC\I Ruirrsnef ®Zoni Status; CUP; <br /> i OWNER ADDRESS (Number,Street,City,State,/Zip) y� u 1_ e Restriction;CSM <br /> ?JO• '&1( 1:3 Li-I 13G � \�� 1" i.A.!` 53911/40 fiance(# ) <br /> HOME PHONE X CELL PHONE E-MAIL ADDRESS <br /> '2-0-2q6°3212- 720 ZtV'..32t�} K.N R- (R • L •1.-4-i(\L - 'ckk") . •te Plan n to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION a udes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -'1;bp 0.►S01"-, ePte>' LAVE > OMS LA-C- al S' Plan' uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Of eptic <br /> / i2o3 s--stir(.L UAkie (203 ulNC <br /> V (City,State,Zip) (City,State,Zip) ®S ckS <br /> m A-t --y-IL L f J( S 3S -1 (n 1,\42s,1,1-.p L 1w( S-36_7 <br /> PHONE HONE RI Site Pla a r0 I from <br /> bOi( - G76-- SSO© bl`t- -N. `5-5-00 applicabl ship. <br /> E-MAIL ADDRESS r, E-MAIL ADDRESS <br /> W�1�ct ;r cro n` � vJ.c•‘i e uxtA '.. YkNNE -- Rfigaicans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ® levat of property <br /> PARENT PARCEL NUMBER:El PARCEL Ot�,p� -i4/1—low 0 CURRENTZON.INi:jr,)-7 ACREAGE:2.- s/ ge drawn to scale. <br /> NUMBER (f11• !� I low V R1tir rL�.r4 <br /> TOWNSHIP: SECTION: <br /> I1 GIX fsi A j t j 1/4: 5 w '//'/4: pj Driveway permits <br /> ADDRESS: i <br /> (state,county,town) ; <br /> 11113 S Cce r Gk Q <br /> CSM:f O LOT SUBDIVISION BLOCK/LOT LLB S nary p <br /> 1 2J 72— I (ptbli ,■.rivate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 14EvJ' toNisrriN G"(IOr.9 3 sit-'t vi■ j ; 'B0�in) 140 one ni District <br /> IA1his project is a new building or structure. ) fitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ^ El ' Address <br /> EWEREPTIC 3- V O )e —�0 j/ .sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including base nt) <br /> 22.., j k, F plain/ <br /> S o (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 2-05C- 1ST FLOOR: SiOnCOrt 1[e a-rmit <br /> -Z2h j TOTAL SQUARE FOOTAGE: 4, (slopes, a Stu 1 1 _ <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access 1 t <br /> ii SOO �o rj <br /> In - <br /> view Locatto - rvey <br /> ESTIMATED CONSTRUCTION COST: op, <br /> (Please round to nearest dollar) ♦ -+ -+ ♦ ♦ ♦ $ I7/, 'V/` a =.vaitabie _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Mg() ['Don't kn <br /> 2. Is there a wetland or floodplain on or near the property? QYes 'o [con't know <br /> 3. Have you talked with the township about your project and are they in agreement'? I (es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Da Jo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> [g 6. Is a location survey required? (see reverse) 'es ao ['Don't know <br /> 7. Is this to correct a violation? ElYes Jo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► ♦ —► <br />