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tiSMPP.PMENT-1.111A:! • :- <br /> ZONING PERMIT APPLICATION www.countyofdane.com . <br /> 1 PRO 71_;Waia�.�—71-'� �: ' .. . . 7 . r . ', i CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �3ec^G (.?0_-\ n Zoning Status; CUP: <br /> OWNER ADDRESS (Number,Street�]j City,Statte,Zip `� Deed Restriction; CSM <br /> 5C`73 {Prerce0(fe_ lK(l. Co e GrdJe( L 535 27 Variance(# ) <br /> HOME PHONE CELL PHONE E-MA1 'ADDRESS - <br /> 61) X37-622O5 Site Plan drawn to scale <br /> AGENT=INF ORMATIOi!I. ', z j _tire CONTIACTO�t31NFORI/�T10Nyr3= and includes dimensions <br /> A T NAME CONTRA T R NAME <br /> L)O� 4e.1k C ec r n Site Plan including location <br /> AGENT ADDR S CONTRACTOR DRESS of well/septic <br /> lG 07 H-.3 i O. <br /> p O. 0 T30ie <br /> (City,State,Zip) (City State,Zip) ['Setbacks <br /> YYb rs ,1 LJT2 53 5-5-1 ro,„c , w __ S-3 3c 3 <br /> PHONE PHONE `� n Site Plan approval from <br /> (yC3%' 333- 74 ( o _a Y�CI XX:) applicable township. <br /> E-MAIL ADDRESS (� E-MAILADDRESS - • <br /> -\O J* 6 Y _'\Lctirvns con- n Floor plans to scale <br /> PROP`E,RTY/LOC[A�TION INFORMATION :(http 1/accesidane.c0,drane:vin,us4 ,^ ' Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> E( PARCEL 7 ,i p frontage drawn to scale. <br /> '+--'NUMBER <br /> Obll�o3`I�OS�"� ��-�� ' � <br /> TOWNSHIP: - SECTION: <br /> `� , , O Driveway permits <br /> SO \ PS�� �� ...‘3,3 �' �4�' (state, county, town) <br /> ADDRESS: <br /> O Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT-INFORMATION `s • S2,�,I RtrV Th1A <br /> PROJECT DESCRIPTION: Bey _ ,'� <br /> 0- . e # -Tip <br /> Ye �4(e 5� Y ��o �� n i t, - <br /> �This project is a new building or structure t•M lad 9 4'=-7-1-1-W'' <br /> ['This project is an addition/alteration to an existing building or structure. • r � = <br /> SANITARY SERVICE: PERMIT NUMBER: Ft-: , .,t1... t-� <br /> k <br /> . [)EWER . FIEPTIC r e. ,% t1 <br /> ' E E <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1 "fi__:;" <br /> ARE A TO NEAREST SQUARE FOOT ' �• •-;' �- ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) •--, i-r <br /> ':is Dt o P 9 4'0 . 19 ert _ <br /> BASEMENT; , 1ST FLOOR: <br /> 1 TOTAL SQUARE FOOTAGE: 1 ,r---_::''' <br /> ale '° o- <br /> 2ND FLOOR: 3RD FLOOR: kU � t „� <br /> J ��'e'"—l-L e.,a. e 3/*" <br /> ESTIMATED CONSTRUCTION COST -r'� , ::,:c t _e m ) <br /> (Please round to nearest dollar) '� ♦ ♦ '� �—_m-- _ '' . <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ®No. IDon't,know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes o ODon't know . <br /> 3. Have you talked with the township about your project and are they in agreement? , Yes DNo. . . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes 123IN9 <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) - Oyes IN i o ODon't know <br /> 7. Is this to correct a violation? EYes NNo . <br /> • APPLICATION MUST BE SIGNED <br /> • • - - (Continue on Back) -4. --► --► <br /> say-1a2otos) - <br />