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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> f i 5 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 8Y/0 /M r �� i.�,r•�)% �ocr <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 715, 9 C j=!?OY 7753 cYci V 0c cc /-opt(ki ec.u_sc tiltllGr-L04 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 14'bc( /9,1'1 —c k.' C di't CO. -1:1/0l 1/C);fe 1e,s-5 ❑ Site Plan including location <br /> AGENT ADDRESS �/ y� CONTRACTOR ADDRESS of well/septic <br /> 5-00–E t%rDiF��.l 5 VIE 5-07E Go iF ery _y_0)(_ E <br /> (City,State,Zip) c,� (City,State,Zip) ❑ Setbacks <br /> Orli / lie 13i44-1. /L_0000 S PHONE/47 —f)-wi ) iC Co 000 ❑ Site Plan approval from <br /> 51 iLl L/O 3 3/0 E U 7 17 5 / a 8 p / applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> icbt-r-Cl.Q. co✓lc0r,J104 wireinS (orwl ,l'Y l3ci(/ol 11--.0_,(0 nc0,171/q wi elsSS.(•.)❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wLus/) <br /> PARENT PARC LNUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL ,�QQ c, frontage drawn to scale. <br /> NUMBER �7/O lC(l LP/CU a <br /> TOWNSHIP: SECT/N: 1 A I E 1/41/4: V1J ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> g S 8 S v'Q+i/'/ (.)rl'✓.e_ <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> v <br /> Loy Q 1./ .6())' ycy) 1.3 (public, private) <br /> PROPOSED PROJECT INFORMATION € "` E , <br /> PROJECT DESCRIPTION: of kx ci o(,vl I.—Cry-1m_40 ex rS�)'0 4-01,1)4", bl•ne t- CU I p 'e ms <br /> p(c(ce� Q. ba on concrere Fju a0--rOV) zont G .. : <br /> CI This project is a new building or structure. ' <br /> This project is an addition/alteration to an existing building or structure. ,: <br /> SANITARY SERVICE: PERMIT NUMBER: U rAural Addess : <br /> s <br /> ❑SEWER ❑SEPTIC ne si 1� <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) °TAM '‘..i.,:11: , ' , <br /> hsad <br /> AREA TO NEAREST SQUARE FOOT: <br /> ., z <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: _ ' � �'Ck. `w'f . + , ' , 4 < <br /> �, TOTAL SQUARE FOOTAGE: ,�, :,, <br /> 2ND FLOOR: 3RD FLOOR: 3 <br /> 3�� '�k <br /> mss+";s4 3',° b?.�q <br /> It r <br /> e <br /> ESTIMATED CONSTRUCTION COST - L F 41 <br /> -► --► ♦ ♦ ♦ ♦ $ 3� ac S <br /> (Please round to nearest dollar) i t , <br /> : <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don'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? ID Yes ❑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) ❑Yes Ja No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes p No <br /> C ki ol } () .--7 <br /> ,Q e Z C 1 '��--7 APPLICATION(Continue Back) -+SIGNED <br /> 545-112(4/08) ✓� cT Continue on Back —► <br />