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ZONING PERMIT APPLICATION w w.countyo dane.comi SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW ER NAME r ,� `r [� <br /> //`� �v���'` ' _ Wing Status; CUP; <br /> OWN R A DRESS (Number,Street,City,State,Zip) <br /> a I I l �` L2o W( I Swig ��\ Deed Restriction; CSM <br /> j ,RGtn l ( CJVLS t L Variance(# ) <br /> H E PHONE CELL PHONE G E-MAIL ADDRESS <br /> - [�20 , —1'l 2— COCPlan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM COgRACT NAM , <br /> 1--e u Ji L (GLt crvi..A.4 kC$_ ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS _ of well/septic <br /> [-2,0 (AM LS D 4- <br /> (City,State,Zip) (City,State,Zip) - etbacks <br /> j of r5 w\ t D5 X 3-703 <br /> P NE PHONE c � CI Site n a royal from <br /> 441 1 -. /cb 20 applic township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PAR EL S MB R: CU ENT ZONING: ACREAGE. eaon of property <br /> ❑ PARMCBEEL R D ° -.1�-b v�`5-o r-C 1 -7L( frontage drawn to scale. <br /> le. <br /> TOWNSHIP: SEC.. 01 <br /> j trIA 1+ "F-(‘e LAO 1/a: 141/4: riveway permits <br /> 'ADDRESS: ��"" l ' (S ,county,town) <br /> `U� C FA Ain() t�1. c u(K) <br /> CSM: " LOT BDIVISION BLOCK/LOT Sanita •- II Its <br /> )k<d) AL \ .( (Pub <br /> PROPOSED PROJECT INFORMATION Pt, STAFF REVIEW , <br /> PROJECT DESCRIPTION: <br /> lie W m. (c4,st wAAc_ W" Wing District ' <br /> . his project is a new building or structure. P matted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: "" "; r � <br /> ❑SEWER PTIC 2 Q (ne ' !sang s `` �t <br /> i <br /> HEIGHT IN FEET [ NUMBER OF STORIES: (Not including basement) <br /> 3 / ► e i�•i 4(affa in/ <br /> `c Sh• rid (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) - - - g 0, <br /> Ere o - •ntrc Permit <br /> BASEMENT: 1ST FLOOR. w <br /> 1 1 .53 3 i G 0 A))-c-,k S j TOTAL SQUARE FOOTAGE: + (slop dist,iti?an e, ,' <br /> 2ND FLOG J 3RD FLOOR: ` fi�i sC S5 <br /> z� ti) 4 ' 3� <br /> rt Revi atidn Survey <br /> ESTIMATED CONSTRUCTION COST: $ S� and a Ieroptions <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 -4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? CI Yes ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes t5klo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave bank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No CI Don't know <br /> 7. Is this to correct a violation? ❑Yes _o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —i• —► -* <br /> 545-112(4/09) <br />