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ZONING. PERMIT APPLICATION www.countyofdane.com ;.SUPPLEMENT to Web�App#
<br /> PROPERTY`OWNErtINFOIRMAT N _,:Iv f.<, %, z-- - ;._ r,y-! ,__- f_._'; :,1'` CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> J 04 Ai ZPL(e n Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 7f (, y (o Ivor ' l i/� Variance(# ._ )
<br /> HOME PHONE CELL PHONE E-MAILADDRES�$ _
<br /> 5e '1 : '''' -'.' n Site Plan drawn to scale
<br /> AGENT{INFORMATIOtt ;,;,' _•ti,u li LCONTI ACTOkiNFORIrkION t y y _; and includes dimensions
<br /> AGENT NAME -CONTRACTOR AME
<br /> /.'Q , .5/r 4.,-44?rxvie. V/ CA_.. 54 , t_e ❑Site Plan including location
<br /> AGENT ADDRE S -r CON TRACTOR ADDRESS of well/septic IT
<br /> S (� ❑Setbacks
<br /> (City;State,Zip) c kJ (City,State,Zip)
<br /> H ` aj; J 3.s-S-S
<br /> PHONE ❑Site Plan approval from
<br /> > [
<br /> 2_, - ©cS Co - applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS - •
<br /> A9 _ t ♦ ekr.ee IT Ell Floor plans to scale
<br /> PROPRRlY/LOCATION INFORMATION (http.f/accessdane.co.cane:vp.us/) ; ''--' 1--1 Elevation of property•PARENT PARCEL NUMBER: • CURRE ONIN . ACREAGE.
<br /> ❑PARCEL
<br /> frontage drawn to scale.
<br /> NUMBER CBef' 16`� 6113-7 /
<br /> TOWNSHIP: - SEC ON•
<br /> �' ,/, fG l,/4 ❑Driveway permits
<br /> ADDRESS: (state,county, town)
<br /> 4/6 y c lov- - - //y/ of .
<br /> ❑Sanitary permits
<br /> CSM: LOT 2 5 BDMSION BLOCK/LOT (public, private) •
<br /> • ,r (dew.
<br /> • ; I • ; I - ∎. ' -..,
<br /> - ST T°.�1 °
<br /> PROJECT DESCRIPTION: ._74-4,- -7.-,t. -7 ,. a . -F -`�-
<br /> /2 / ccreE'� _wi/ieA V I . }- = ,�4", ,mac°`a
<br /> • This project is a new buildin or.structure. t ..:_ -P Pral.; `"' ''
<br /> 0 P 1 9� � T ��"d se
<br /> ❑This project is an addition/alteration to an existing building or structure. -ii t " "'"
<br /> SANITARY SERVICE: PERMIT NUMBER: . , °e T„,k
<br /> . r)EWER . PTIC ' �4t 6 s_�� s „
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) --_-= '--•..-.,.., h-
<br /> . . GI a/POeeo ;i.0*a4;N:AE
<br /> file aril to '' e
<br /> AREA TO NEAREST SQUARE FOOT: ' _-�,
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) c`` '-
<br /> BASEMENT: 1ST FLOOR: p e : r a e'11 1 ,
<br /> 2Art 4, TOTAL SQUARE FOOTAGE: 4, `A �,�O° ; 5 Q
<br /> 2ND FLOOR: 3RD FLOOR: -- ��,il .�# F'.
<br /> X5'7 � �e �]QC � -� e � .
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ - . ♦ A� e e P;f i/
<br /> (Please round to nearest dollar) /g 0O - � = z e—._ j
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [.]Yes'' Mgt,o.- ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes i!di o .❑Don't know .
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ,,m, o. . . _
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? ❑Yes N : .. S .
<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) Eli' s !�! o ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes cd o .
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) •—► —► —0-
<br /> 545-112003) -
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