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_ O sii-Sk) = 5 9a— <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1L <br /> _Rob --Pc.14N. i ►ctf N Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street ,State,Zip) Deed Restriction;CSM <br /> `31013 Suscty C;ur+ Cross-P1ciiNe. ■,0 535?$ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> T-1 CAS (D►qi . • -EsS4 3 ,r A e - ^ (1 RSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Z-Gv►je. Zc Cep., Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRE of well/septic <br /> 80G L3'i rcht.r r3 . SS <br /> (City,State,Zip) (City,State,Zi 2.1 `-g Setbacks <br /> PHONE <br /> cross VIG t►s.s 1 u.. . ,A <br /> PHONE 4Site Plan approval from <br /> (sue q% -43145 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT Z NING: ACREAGE: levation of property <br /> ElPARCEL �, o S O /� _ q S ontage drawn to scale. <br /> NUMBER ''1 I <br /> TOWNSHIP: SECTIO • � / <br /> M cid leiut.J _ 1/4: iv 1/41/4:',,v ri w permits <br /> ADDRESS: 1 (Sta�Unty,town) <br /> SJ''"iv\ c 12 - c)j� p ° Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> '71 -'. 5- public,private) <br /> PROPOSED PROJECT INFORMATION °, -i„ =:. <br /> PROJECT DESCRIPTION: s t Q. <br /> IA This project is a new building or structure. Permitted ise <br /> This project is an addition/alteration to an existing building or structure. . <br /> SANITARY SERVICE: PERMIT NUMBER: Li R• r Address <br /> EWER FIEPTIC p- 1 �.. .,`s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 X*etlattilin/- <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shorelland (att iment) . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '",,,,Ii.:, . <br /> BASEMENT 1ST FLOOR: rQStf <br /> t �rrtt <br /> t <br /> Ol �4Lr V4-fig/P0-5-00 S ttt3,f <br /> 2ND FLOOR: 3RD FLOOR: -7a)- 1 0.0 <br /> -,Li' •on Survey <br /> ESTIMATED CONSTRUCTION COST: �" .1 :;:_•(Please round to nearest dollar) "'∎ "∎ $ -Sa- SK k,°° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes 1No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes to DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes �EIP,,�,o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes Jlo <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) Dyes Jlo DDon't know <br /> 7. Is this to correct a violation? Dyes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -* —1 <br />