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ZONING PERMIT APPLICATION ii .countyofdane.com SUPPLEMENT to Web-App # <br /> ww <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ME <br /> 2 P ne_ L L C Wing Status; CUP; <br /> WNE4R ADDRESS (Numbermin Street,City,State,Zip) W 3 � Deed Restriction;CSM <br /> HOME PHONE CELL PHONE <br /> �� E-MAIL ADDRESS // Variance(# ) <br /> w 3 -2 17b ' - 2971. ( I r, _, L., I hPmQS•Co fY) Si drawn to scale <br /> AGENT INFORMATION I COWTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRA'TOR NAME <br /> �R� JtRT� �ii Soh /�omeS Si an Including location <br /> AGE TADDRES CONTRA TOR ADDRESS f well/septic <br /> 2��2 i.Ly mni 21f - NI ( mm 371/ity,State,Zip) <br /> (City,Stat¢,Zip) acks <br /> PHONE PHONE J ❑Sit Ian a oval from <br /> 4,08-438- 2q (pah--ii38 2q-% ap . e township. <br /> E-MAILADDRESS f E-MAILADDRESS t <br /> oi" ®C-t ekr O-kio M(,S•(Ate'\ r ,, n C)ci 4 rl Y10(1'1LS•(e)114 or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) on of property <br /> PARENT PARCEL NUMBER: CURREN NING ACREAGE: <br /> PARCEL f fry outage drawn to scale. <br /> ❑NUMBER ODD - �t-66 9-a REs --/ I <br /> TOWNSHIP: SECTION <br /> net t4Lt,ivn IP 1/4: 5 WA: ❑Driveway permits <br /> DRESS: [� / (state,count n-.3 <br /> 7 Q A e # P-r ita - • its <br /> CSM: LOT SUBDIVI ION BLOCK/LOT — - (public, •• g64 <br /> ' ��� )17114f Ldp 9 N <br /> PROPOSED PROJECT INFORMATION ", <br /> PROJECT DESCRIPT <br /> 5 t f-N:aii( I ti /4,6.) 6/1 SlWc a✓► ylaing <br /> its project is a new building or structure. P Use?. <br /> ❑This project is an addition/alteration to an existinij building or structure. <br /> SANITARY SERVICE: PERMIT N BER: <br /> JEWER EPTIC 13- )b - t Z ) 5 r° . ) <br /> HEIGHT IN FE T NUMBER OF STORIES: (Not including basement) <br /> 'rS ,....S Z FA s t . =4 t <br /> shore,. ,a':.''t,'r.., = )TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gai.ages and above grade decks or porches) <br /> BASEMENT:51 1ST FLOOR:13 j TOTAL SQUARE FOOTAGE: j y� , -,, <br /> ZL7Il/ n . vac,. <br /> 2ND FLOOR: 3RD FLOOR: 5l 3.7 <br /> It( / ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ --► ♦ $ `,j'� ^ a a ( ...options. <br /> (Please round to nearest dollar) ��J+ d° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EK ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes E' ❑Don't know <br /> 3. Have you talked with the township about your proct and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes c❑N( <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) es 3406.___ODon't know <br /> 7. Is this to correct a violation? Dyes <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - –0 <br /> 545-112(4/08) <br />