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ZONING PERMIT APPLICATION www.countyofdane.com ;SUPP, EMENT to Web•App <br /> RYR.-u.IFRTQN Y Ftz�--� . +.� �'PROPET :OWNENO_MAI 1)Y-'= «,ce f'" Y " . -T4 ? := Cl ns _T-l� CUSTOMER TO PROVIDE <br /> 7RNAE / • <br /> T/C— X/P/eV lam" - n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zi ) Deed Restriction; CSM <br /> 4 7 3 117e-AJ / ,� Z. Jc So ti .iUj Lo..r S-=4`7G Variance(# ) <br /> HOM 'HONE CELL PHONE E-MAIL ADDRESS - <br /> 6 le y`1/f K7-ZL n Site Plan drawn to scale <br /> 2 + to j .c Q.�.� .�-v _._ _ <br /> AGENT INFORMATION, � ti �CONTI ACTO�t 1NFOR IAT1oN �, y, _fin, and includes dimensions <br /> AGENT NAME CON CTOR NAME <br /> S / n Site Plan including location <br /> AS.d a, L T � t�� �DN S'TieGG7t0�' <br /> AGENT ADDRESS ) CONTRACTO DDRESS of well/septic <br /> /y i0 & a v/ 4 /y/v /Se n471w b <br /> (City,State,Zip) . (City,State,Zip) < ❑Setbacks <br /> S e <br /> Pkqic w <br /> — s s3s ro S'(i A, Pe ;Rim t s sio <br /> PHONE PHONE ❑Site Plan approval from <br /> 60 g--2.1-2_,-ZS 8-2._ 1o61'-2)2-Z3k2- - applicable township. <br /> E-MAIL ADDRESS E-MAILADDRES <br /> . 23 ,A,s-'2v ,PA, ,[ Floor plans to scale <br /> ;PROPoRTy/LOCATION 0.01- AtiQMi kittpe//wio: iiane,co,vane.vlrl.us1) _,-- _s-.- ❑ Elevation of properly• <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ <br /> PARCEL frontage drawn to scale. <br /> NUMBER G11/O /. -Z 92.'452441-f <br /> TOWNSHIP: - SECTION: <br /> -B Q I C7 e)( 1/a : %IA: ❑Driveway permits <br /> U <br /> (state, county,town) <br /> ADDRESS: AV�l� - <br /> 6 311 oo�1,q (. i�LL Ste „ {�e� ,P,c r .'wS <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> • <br /> PROPOSED PROJECT_INFORMATION. , _ ST W R N <br /> '; - `�PROJECT DESCRIPTION W^ i -:._� <br /> -_ <br /> IO <br /> ��f his project is a new building or structure. L 7':'-,"' f �.�, ' <br /> This project is an addition/alteration to an existing building or structure. k _• ,..,„ <br /> SANITARY SERVICE: PERMIT NUMBER: " w <br /> k <br /> EWER EPTIC -ak.fi e . e - h - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ` <br /> tLe/ Oet@ a 1I c1 <br /> 3 AREA TO NEAREST SQUARE FOOT: X10 as ee <br /> 1 - `- ` ` r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) --m om '--- "r 4 <br /> D eA -o. •• lee <br /> • _" <br /> , <br /> BASEMENT , • 1ST FLOOR: ` ` �,, TOTAL SQUARE FOOTAGE: j, ^- r p <br /> . —" aw X Cii:I . <br /> 2ND FLOOR: 3RD FLOOR: L. -4A-..7 <br /> 1/...0 '`"` �` � f :-r <br /> • <br /> ESTIMATED CONSTRUCTION COST: //mac .' .-° <br /> (Please round to nearest dollar) c-S'pd, _ ` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? Yes IQ o EDon't know - <br /> 3. Have you talked with the township about your project and are they in agreement? [Wes ❑No. . . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes QNo • <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) QYes QNo . ❑Don't know <br /> 7. Is this to correct a violation? S ❑Yes ON . <br /> APPLICATION MUST.BE SIGNED <br /> • (Continue on Back) ♦ ♦ ♦ <br /> 545-112{4ro6) <br />