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„,,[vfa,,,K__5 k.(,,,,,,le,-, _ ivi-p - <br /> ,q <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION GUS MER TO PROVIDE <br /> fiOWNER NAME /j� <br /> ler P K. ' )74/4o .-f K 4 ee Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,(iti ,State,Zip)/ / c 7I Deed Restriction;CSM <br /> us SD ... l '1 r/ . i`/!// ”'k C I / Si T k Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 7• -e(3 V Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions A645 <br /> A NAM / CONTRACTOR NAME _ i <br /> n ` c..L.«rgi 64% (p„s f�. 4,y,i L(,( ❑Site Plan including location <br /> A NT ADDRESS) CONTRCT ADDRESS L nfwaj sep e �prd\fii <br /> ((( i State,Zip) <br /> (City.,State,Zip) l (►� Setbacks <br /> PHONE G PHONE M k.'l a Plan approval from <br /> C. O D L t f' 79 I It (,,d ' C, yC 3 7 ? / 4 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> 1 PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wAGLE7) n�P�,ation of property <br /> PARENT PARCEL NUMBER: CURRENTZONI G:(http://accessdane.co.daAnceR.EwAGLE74 <br /> I PARCEL frontage drawn to scale. <br /> ❑NUMBER oS� 0 9 0� 3oa!s�►i ,O N: G g <br /> TO HIP: SECT ON: <br /> x u/' Q_ '/<:4/4/ 1/<1%: .s� way permits <br /> ADDRESS: Y ..., p,,( (state,county,town) <br /> 10 c'b 14 y(o � e ti, anitary permits <br /> CSM' LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION a r i " <br /> PROJECT DESCRIPTION: /( J� :. °" 1 k <br /> �� Irv ' <br /> V -i s <br /> 7 sE ' <br /> • This project is a new building or structure. :-`�� <br /> ,a his project is an addition/alteration to an existing building or structure. 4. <br /> SANITARY SERVICE: PERMIT NUMBER: "�° <br /> III.EWER 410.EPTIC '� `� "' <br /> HEIGHT IN FEET: i V NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: � e <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: - ffi av <br /> (2 ,S TOTAL SQUARE FOOTAGE: it 11 41 �$ <br /> 2ND FLOOR: 3RD FLOOR: ' v,_ <br /> ...-070-- -. <br /> ESTIMATED CONSTRUCTION COST: �+y�/� "W s g 4 <br /> (Please round to nearest dollar) Z�Wv <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ❑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? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes RID <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ❑ <br /> ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes MNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ra',0 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(8/09) <br />