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I. ' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION s,;,; _ _'4% u0? ; x,_."< 'tt: , w CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 5 C C Ir'-; o r S, ti,,L.C--; Dom. e,,o,-, .re oningStatus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) -ed Restriction;CSM <br /> I I I p 9 ^,r Prri-}-o T -I P 2,7 ivt/�i-r� 15 D n-J", / ,S 3 71 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> LII ite Plan drawn to scale <br /> AGENT INFORMATION ;. CONTRACTOR INFORMATION. t :nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ' (San-) S( G 4-3 L Fit/ .i4 • Site ' eluding location <br /> A •DDRESS CONTRACTOR ADDRESS of ptic <br /> 1;,2_1 f�L)S Le.... -1 S 1- - <br /> (city,State,Zip) ( ity,State,Zip) IN Setbacks <br /> PHONE PHONE ❑ Site P a oval from <br /> 60 6 --2 y ( -71 7 applic township: <br /> E-MAILA'%RESS E-MAIL ADDRESS <br /> ■ JO (S ti) s-16 sj�. g.rif(--t .'U Floor pl o scale <br /> PROPERTY/LOCATION;INFORMATION '.(httpa/accessdane.co.danewi.usn , Elevation of property <br /> PARENT PARCEL NUMBER: f CURRENT ZONING: ACREAGE: 7 P P Y <br /> ❑ <br /> NUMBER © /0 / .3'2-27 f 4'"�C— Z p +S 4c E frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> : ❑ Drive : • rmits <br /> �5 b N 1 ' 1/1/� state • n t <br /> A DRESS: ( ty� own) <br /> 2.-©33 DISH H Hi c-rl� - <br /> ❑ Sani - , p- its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> r7.-0 '40 1 -.7 O K - C> , (publi • ivate) <br /> PROPOSED PROJECT INFORMATION. ' ' A - ' " <br /> �� <br /> PROJECT DESCRIPTION: r �� , � - �- 3 �A�z� <br /> 1 � a <br /> \ 3 3T may, .ry <br /> This project is a raew ( E r`- c <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT N R: i� °" <br /> ❑SEWE SEPTIC �� `; <br /> HEIGHT IN FEET -T13 NUMBER OF S s RI : (Not Including basement) r? � f" <br /> AREA TO NEAREST SQUARE FOOT: ® 41 : 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ;� ,ti ,_ <br /> BASEMENT 1ST FLOOR: �o V <br /> 4. TOTAL SQUARE FOOTAGE: 4, s• � ,.�,t`�7g-fit :::' <br /> 2ND FLOOR: 3RD FLOOR: C <br /> : �' <br /> ESTIMATED CONSTRUCTION COST to r 1 • ••a p -i` <br /> (Please round to nearest dollar) ♦ "� '0 9' "� 4 t Z a }.1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑ -s ❑No ❑Do ' now <br /> 2. Is there a wetland or floodplain on or near the property? ❑ e- ❑No • Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ■ • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes di o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le- - blank if •ne) <br /> 6. Is a location survey required? (see reverse) id Yes ❑No • Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -1 -► -0 <br /> 545112(4/08) <br />