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(914 , t V SUPPLEMENT to Web App;# <br /> ZONING PERMIT APPLICATION www.countyofdane.com . <br /> 0110PERTY`OWNER71NFORMATION r.,rA;:` :z,, _r; }. _ _ rh . .__6_-, ` :z---4=T ,,'. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ura! y r ' CZ– n Zoning Stat , CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> n Deed Restriction; CSM/W £t ( ✓ 1-y- RA CS Q 0'c-`e( rc "1 � <br /> I , Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> 66 i -?6c t- <br /> 8ZZ C S c c Z 7'a �1rx: i C-rore\ I I Site Plan dr to scale <br /> aAGENT TWORIlliAtilikMnIBPMM CCONTI ALTO D FOR1Ig!iON j,- and includes imensions _ <br /> AGENT NAME CONTRACTOR NAME <br /> La fry )4 pps n Site Pla In ding location <br /> AGENTADDRESS CONTRACTOR ADDRESS'I of well/s lc <br /> 371 7 7 ok<,, 0-cad <br /> (City,State,Zip) (City,State,Zip) , O SetbVi <br /> f fore54 r V,VJ . 535_3 2. <br /> PHONE <br /> PHONE ❑Site PI.r :ire -1 from <br /> 3-75 - `63 3 - appli j tF V. nship. <br /> E-MAILADDRESS E-MAILADDRESS Floor laps t scale <br /> I4h . ►Scz ck4- r' net ❑ P <br /> `.=PROPERTY/LOCATION_IA1FORMATII-OM>_ti iPa/'accessiiane.co,danewu`i us/)' . n Elevation of pro erty <br /> nPARENT PARCEL NUMBER: CURRENT ONIJ ACREA I ,F� <br /> NUMBER o;Oy o7/ '-/gI '`jloo-u p ` frontagedra to scale. <br /> SECTION: <br /> D.e-el 1 /S -7-1 Z.. 1/a: 141/4: ❑Driveway,•e Al. <br /> ADDRESS: (state,c�� • n) <br /> /'1 / c 4- Load QB Oeer rif(c' (iii- 5 3c.3) O Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT-INFORMATION T';< ` j 'W <br /> PROJECT DESCRIPTION: ' w -;4f4-'. , - t <br /> t sue' rte` <br /> iii +0'?r � � <br /> OThis project is a new building or structure. ,e. ,° 1 ed , <br /> 1:741-his project is an addition/alteration to an existing building or structure. - <br /> ,L-- — <br /> SANITARY SERVICE: PERMIT NUMBER: r 9 a <br /> . *EWER . FEPTIC = E as .A.`4 '" � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> _ <br /> 1. — e <br /> AREA TO NEAREST SQUARE FOOT '_ 110:::i 6 er a, efi <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -�D a�.---_ ' - . & <br /> / � <br /> • <br /> BASEMENT: 1ST FLOOR; r / ^ ,� o ��� <br /> NI A• 27 u) ' I� �� 4, TOTAL SQUARE FOOTAGE: 4, � t�� ,�" ;,, <br /> 2ND FLOOR: / 3RD FLOOR: - r r , <br /> ESTIMATED CONSTRUCTION COST Be Q�gr <br /> (Please round to nearest dollar) ♦ '♦ ♦ -► -P. $ g7)000 �'" <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes ' . No - (Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? QYes to ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? OYes ONo. - . <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? C]Yes : ONo . <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 END - ❑Don't know <br /> 7. Is this to correct a violation? - Oyes INo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -. -4 -► <br /> 545-11 2{4/OB) - <br />