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c s Pt°corda sp Q 3 GS <br /> • <br /> eONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#. <br /> PROPERTY-OWNER:INFORMATION' ,__ t f4; ; -,�-t .,-._.'< := ;.t CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Wtri1 4- -Tg'A Cy • TRAV 1 S &14oning Status;CUP; — --E <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM / <br /> '7873 T-1.-1 to W STov6tiro,.), W I 53555 cl Variance(# ) /�I °c <br /> HOME PHONE CELL PHOQNE E-MAIL ADDRESS <br /> (�OSZOl^ 9�t+ <br /> too8-fo98- • • 00 EkSic-Plan drawn to scale <br /> AGENT INFORMATION .. CONTRACTOR INFORMATION " . ;.< and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C14lZLS m t1.4.E-1?-_ 03.33-r. Lt, 4 ❑ Site Plan including location li <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7)18/A ktaaEy R9. . <br /> (City,State,Zip) (City,State,Zip) 6 Pb5 backs <br /> V(261T6€ G2 %1E la) 53521 PHONE PHONE ,� �G Iteproval from <br /> (ea8^ '07'7 -13( ' P� applia 3�E'l 4 wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS \ <br /> di.%As. on:Itor,eons'rru c'r;e,,�Z•rnc�k\. Caw, loor plans to scale <br /> PROPERTY/LOCATION;INFORMATION (http://accessdane.co.daAnceR.E7GLE77) ; n vatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: "C�"' <br /> NUMBER <br /> ER O of 2ofo45'aoo 9 R --I Z Ac frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> CI-Mt S-T*I'q-/'ek 6. 1A: 5 L, /,A; S E aiargigvay permits <br /> (state,county,town) <br /> 14 C G kizAia. IR O- , ❑ Sanita ermits <br /> CM: LOT SUBDIVISION BLOCK/LOT ub rIV <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: 'r ` € 2, <br /> 5. ,�.. tom)f crAC-t-I�-S d-176c_v_ � 1 C V.• ,Y <br /> XThis project is a new building or structure. '� n <br /> ❑This project is an addition/alteration to an existing building or structure.ture. 3 '' �q <br /> SANITARY SERVICE: PERMIT NU 1 , , <br /> ❑SEWER SEPTIC �� , �' ` .. _l <br /> T 4 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement <br /> **ftjrn .,_� a <br /> AREA TO NEAREST SQUARE FOOT: ,:::- � �z <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) at �- -i <br /> BASEMENT: 22.3 1 1ST FLOOR: ` 223 : 4i) � �F <br /> $, m �(p$ TOTAL SQUARE FOOTAGE: ''. '�E� %�� <br /> +•.- _ - 4 a l 7,, s ;� e <br /> 2ND FLOOR:gas 3RD LOOR: <br /> v. Sri/ J Ct1 582 '-]v7 Q� <br /> IRACE 1 s2. r� � ��r 1 y <br /> ESTIMATED CONSTRUCTION COST: - c q �g0 ,t A A <br /> (Please round to nearest dollar) � �k M '=',114, ,r �� <br /> 0 1S+Sn_ G) �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ❑No ►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 ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ;�No <br /> ,this project associated with a rezone/CUP/variance(petition/appeal# IOOO ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) CI Yes _No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes XNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />