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;:.SUPPLEMENT to Web,40* <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> 'FROPERTy;ow.NERyINFORMATION ,A-:'9.�.fs ai-ow ii ;a,, � ,Gt T`3_ :y- CUSTOMER TO PROVI E • <br /> OWNER NAME /I. rf <br /> � P Isoii. zoning Status; CUP; v <br /> OWNER ADDRESS (Number, et,City,State ip) - —Deed Restriction;CSM 528'4 <br /> 11- g4'i-p10r / c - C/✓Siti1/ lu-I 5 5s? Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ('o '149 526 Site Plan drawn to scale <br /> 'AGE WON FORMATIOIt1, ` ti fsl CON1*.CTOItINFORI�gT10N •?; ; and includes dimension <br /> AGENT NAME CONTRACTOR NAME <br /> Cg.Site ' - ding locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septi . <br /> (City,State,Zip) IKSetback4 3 d/���f t7 <br /> (City,State,Zip) <br /> PHONE PHONE VS.Ite Plan approval from /Y <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS 43,\I.- <br /> Floor plans to scale <br /> PROPERTY/LOCATION_NFORIVIATIONAlli tiolgal c_essilane.co,d_an_e*,.usl)y Win; ►� -vation of property / <br /> PARENT PA CELNUMBER: CU RENTZ ACREA <br /> EiPARCEL 0 ?/2 -.11 9— ? 22 a 'l— 2__ ' � 3 a frontage drawn to scale. <br /> NUMBER 1 <br /> TOWNSHIP: SEC77: <br /> C C- 1 c�o! /( '/: SF Y4%: S .4 Driveway permit <br /> ADDRESS: <` (state,county own <br /> /1 Sanitary is <br /> CSM: ? , / 1 LOT SUBDIVISION BLOCK/LOT <br /> �lJ v (publi , private) <br /> PROPOSED PROJECT_INFORMATION., • ilSTx►e _RfVIIE KI _� <br /> PROJECT"SCRI N i C C fe se. �J A� 4 o t T � ,� f 2 <br /> U /f c�nyd F . - OZnlaa l�-0IS3r,,.;` ' '17 <br /> •• This project is a new building or.structure. F__ F k � - <br /> P J 9 : P .--,7t-ed se- . t •j- — <br /> nThis project is an addition/alteration to an existing building or structure. n ,' <br /> SANITARY SERVICE: PERMIT NUMBER: �1 SOT ddl , <br /> FIEWER . LA EPTIC .tew ^° �-c t <br /> ��' o0o u t <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) e�3 -- -'"`� <br /> Stiorelaiia 4 atta erft <br /> AREA TO NEAREST SQUARE FOOT 3 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -. r�e- -q <br /> BASEMENT 1ST FLOOR: ,pC 10 1 r upKtT i x._x, <br /> . 7 0 Z l TOTAL SQUARE FOOTAGE: + ...'*-.1,.„i'4 �}]e5"�6StU 2 Can r <br /> 2ND FLOOR: J 3RD FLOOR: / _ aCCeS4* <br /> gitri7=e--- oc-WiloWM- '"'" /4 <br /> ESTIMATED CONSTRUCTION COST: '��g� <br /> -► =► -► -► -► --o Ord a ii gkiie ptrwl$- I <br /> (Please round to nearest dollar) �� r © � - ; � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ' QNo.- -']Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes E]No .QDon'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 ['Ng : .: . <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) ['Yes EJNo ['Don't know <br /> 7. Is this to correct a violation? V ['Yes ['No • <br /> • <br /> �� '^) APPLICATION MUST BE SIGNED <br /> / 2 1 (Continue on Back) -9 -p -� <br /> 545-112-(4/O8) / <br />