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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW -NAME <br /> e-14, .o i ` i •tm:1L11 ■ . LL L •,( oning Status;CUP; <br /> OWNER/ADDRESS (Numbe[�wSstreet,City,State, ipj 0 eed Restriction;CSM <br /> 0 0 t J 10 U3 D?• I G(Q? W5311 ariance(# ) <br /> E PHONE CELL PHONE E-MAIL ADDRESS I <br /> ocz 2.* a\ s ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME - C•NT- CTOR NAME <br /> ' `• . • , L.L.L.C • .ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS O well/septic <br /> (City,State.Zip) (City,State,Zip) pR etbacks <br /> PHONE PHONE • 'ite Plan approval from <br /> ' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> pill loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.d- I - . ,li. levation of property <br /> PARENT PARCEL NUMBER. CUR TZO ING: ACREAGE: frontage drawn to scale. <br /> II NUMBER V I UO` D3 --Li/7'1 0 , 7 VI <br /> TOWNSHIP: SECTION: , 1/41/4: N Driveway permits <br /> Q `= s S�� ■ <br /> state,county,town) <br /> •'DRESS: _ -T- <br /> �� c . •t. .! . .1 Ji A ` 11 Sanitary permits <br /> CSM: - LOT ` SUBDIVISION iiipl::: <br /> (public,private) _■53 () 1 <br /> PROPOSED PROJECT INFORMATION - a"� 17:'!-_Wf:N <br /> PROJECT DESCRIPTION: <br /> IrinIM S gi .-t(2— 2*,,:=,-C:fii ' ,.",i,-. .:-:"::7 '.--1' ---1'.:,:'t''- <br /> This project is a new building or structure. L�� «,11$ci 1: <br /> CI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: kli'..V Ali/4\P-Mil.-17,i- _.----,----.4' <br /> Xi SEWER ❑SEPTIC i <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �r <br /> ICJ ‘" it 9a v efai <br /> AREA TO NEAREST SQUARE FOOT: s <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g c.� <br /> BASEMENT: 1 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: 4, Yp ,3"am r,3i ,, a <br /> 2ND FLOOR: 5 3RD FLOOR' - 4 5 3 .. <br /> v9 <br /> ( �sy <br /> ESTIMATED CONSTRUCTION COST: - ,as '` , <br /> (Please round to nearest dollar) ♦ --► ♦ ♦ --► ♦ •i ----- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes -No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes N No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes YSNo <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) 12/Nes 12allo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ANo <br /> 1D1 v\IS5( APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i —► -► <br /> 545-112(4108) <br />