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ZONING PERMIT APPLICATION www.countyofdane.com <br /> Minr SitriMin <br /> PROPERTY OWNER INFORMATION , __ ..._■-; 4: . CU TOM ER TO PROVIDE <br /> 0 M <br /> R 0 ER NAME <br /> el/ e C h a'd ivi A 1 Z ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) i D e Restriction' CSM <br /> 2.7 fo T� h y q/( r P l�� ri nce(# )• <br /> HOME PHONE CELL PHO E E-MAIL ADDRESS - <br /> '-77 - Z,e Sit Plan drawn to scale <br /> AGENT INFORMATION ''.::,12=',:,;::::2:., <br /> „;', CONTRACTOR INFORMiiT10N 42::V;;; aryd ' cludes dimensions <br /> AG N NAME CONTRAC OR NAME \J <br /> ,p F 1” 5-P rZGrp� El Sit Plan including location <br /> • N DD' • CONTRACTOR ADORES of ell/septic <br /> a - y��.i 77 7G k.I / ✓ 0 / a' <br /> / <br /> (City,State,Zip) (City,State,Z' ) p , tbacks / <br /> PHONE PHONE req r.�/ ( 1-1. 7 if q ❑ to Plan royal from <br /> (o g—27 9-7OJ' plica township. <br /> E-MAIL ADDRESS E-MAILADDRESS . <br /> loor plans to scale <br /> PROPERTY/LOCATION;INFORMATION ,=°(httpe//accessdane co,dan .wi.us/) ;__ <br /> PARENT PAR. L ftL/MBER: C RRENT ING: ACREAGE: Elevation of property <br /> ❑PARCEL I / ?3co ,-. ! frontage drawn ale. <br /> p • <br /> TOWNSHIP: SECTIO <br /> J/ S /d I ,/: S C ,/4,/�•v„.) D Drivewa ermits <br /> ADORES — ,/ (state, ounty, to i ) <br /> 2 7/0 CT // S`'h /✓a/z7 r L1 5,59,0' ❑Sanitary .-rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> publi►, private) <br /> PROPOSED PROJECT INFORMATION ' a STAFF R:0IEW•PROJECT DESCRIPTION: i * <br /> .4 e/ (d' � 7C 5 , on <br /> rijDlsrlet <br /> . rgThis project is a new building structure. -Li Permltte se? <br /> This project is an addition/ eration to an existing building or structure. i ,1;:._ LL <br /> ❑ P 1 9 9 _ <br /> _©`RktralAa ie s _�3 <br /> SANITARY SERVICE: PERMIT NUMBER: r=�� Aka ��3�, l` 3. <br /> (EWER EPTIC Kl.�j.Aka l I, lg� s��, <br /> HEIGHT IN FEET Li NUMBER OF STORIES: (Not including basement) l 4 `y x �' ''` <br /> / Q�.Wetland/Flom t 0 aln <br /> AREA TO NEAREST SQUARE FOOT: ' £Fgrair� - a#ac raept)g <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: • 1 ST FLOOR: C��.�Cp�a�C-o�t'� :;'6,01=C AR <br /> .r <br /> ' . 2 7 X-3 L ♦ TOTAL SQUARE FOOTAGE j, sJo,ems tss �.ban.ce; <br /> 2ND FLOOR: 3RD FLOOR: / Ilirigacc a`` ` ` <br /> Oh erg. x T <br /> • 0-Revie .oc ttbn SQey <br /> � �,r � <br /> ESTIMATED CONSTRUCTION COST: Y <br /> -► =► --► ♦ -► -► rtd:a a able bfln$� E« <br /> (Please round to nearest dollar) / f/e71 r .0!$em u k _;._ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes [jNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes ['No . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes [g[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) alYes DNo ❑Don't know <br /> 7. Is this to correct a violation? Dyes ENo . <br /> . APPLICATION MUST BE SIGNED <br /> C 545-112{4 0 3(4/08) (Continue on Back) -► -I. -► <br /> • <br />