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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 /> i 1 f tkk Rrtct'ei. <br /> ❑ Zoning Sta ;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D ed triction,CSM <br /> 7q rtru' M 5-t Orel o., w-Z ari ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ?3 S-5s3 q S. Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR tIAMc/ <br /> 3'C'f c'fh 11(-L Ve%Kc /`7 o"4 es L Le__ Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> /56S-eb Pi 1 e Stdki^g‘ 1,41 J36.r' Co.i..,YAi, h 4k, LIV <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> otee10'1 ,�. 7.� °veto .-1 Lur J. 7�' <br /> PHONE V PHONE ❑ Site Plan royal from <br /> WV- u V47t '1 yY.- 76 7-4 a plic etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wri.us/) Elevation of property <br /> PARENT PARCEL NUMBE : CURRENT ZONING: ACREAGE: P P Y <br /> NUMBER �� J3�� �, % q v g frontage drawn to scale. <br /> D PARCEL TOWNSHIP: (� I l�� (� SECTIQgh 1/4: ' - 1 1/41/4: �1_ ' ❑ Drivew permits <br /> ADDRESS: 1 I l„X\ (stat ,county,town) • 1 <br /> 7q3 7-r uMa ', s+ 0 Ve 0,-, <br /> ❑ Sanita ermits ��� <br /> CSM: LOT a v DIVISION BLOCK/LOT <br /> (pub!' , private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW" <br /> ION: <br /> PROJECT DESC IPT <br /> 14 - '�. rt K rt►f l (strict <br /> ❑This project is a new buildi r structure. <br /> r�. ermi#ted Use?. <br /> G11 <br /> 1 his project is an additio alteration to an existing building or structure. y <br /> SANITARY SERVICE: PERMIT NUMBER. ❑ Rural', i <br /> ❑SEWER SEPTIC ^� (new itt • <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /8 ' ( ❑'Wetla !. .;Vein/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> - S i= eland (attar; ent) - <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ,/ � $: aa g� <br /> 33 2 , 332. �� l TOTAL SQUARE FOOTAGE: 4, ,, a <br /> 2ND FLOOR: 3RD FLOOR: � <br /> vx 0 Erie, =ton ray . <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ lit) D O and atlleons. <br /> (Please round to nearest dollar) ! �/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑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? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• one) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> $ (10 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -♦ -► <br /> 545-112(4/08) <br />