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• <br /> . ),-- ,', 1,/,11 <br /> ZONING PERMIT APPLICATION w.countyofdane.com SUPPLEMENT to Web-App# <br /> ww <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME <br /> VQ0;40 t L �- L _ P oning Status;CUP; <br /> OW ERADDRESS (Number,Street,City,State,,Zip)) <br /> �} � Q , . �� 2 c ��' Deed Restriction;CSM <br /> -e 4 L-A-k t7 I ' , Variance(# ) <br /> H•ME PHONE CELL PHONE E-MAIL ADDRESS 1 <br /> Ali 43■•• (. R Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S <br /> c - e / DO�-- x Site i ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well tic <br /> (City,State,Zip) (City,State,Zip) In Setbacks <br /> PHONE i PHONE 7 Site Pla ap val from <br /> IS" "Og D r-3 ) 00 =pplica wnship: <br /> E-MAIL ADDRESS E- ADDRESS <br /> WP Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.whusn <br /> ! Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREA E: property <br /> ❑ <br /> NUMBER A°i10. ,©3 I a''-1 - Q R-3 . a frontage drawn to scale. <br /> TOWNSHIP: S CTION: <br /> --A-6\J(� q Wilk{S o� '/:s ,A., : N c I' Drivew ermits <br /> ADDRESS: � " (state, nty,town) <br /> ' itv"ie I - "" Sani . , miss <br /> CSM: LOT UBDIVIS ON BLOC OT . .rivate) <br /> ,a 46■X ■ RA c 1 i PROPOSED PROJECT INFORMATION a ,;-,7f-g.-11.5A--t-d <br /> PROJECT DESCRIPTION —R <br /> r r--^ � ( 1 2. ' 8124 °1°P 1,:.} <br /> This project is a new building or structure. . , 5 <br /> ❑This project is an addition/alteration to an existing building or structure. = v <br /> SANITARY SERVICE PERMIT NUMBER: NA 3 Fri(K-'ft a airC ' <br /> ASEWER ❑SEPTIC 5-3 l�-� ;�-u *° ait g F <br /> HEIGHT IN FEET, NUMBER OF STORIES: (Not including basement) ` 1 <br /> AREA TO NEAREST SQUARE FOOT: SID Co j 1 i , {,3 � -x� - - <br /> (Outside dimensions including unfinished area,attached garages and above grade dicks or porches) -Y .g�r <br /> BASE T: 1ST FLOOR: "� ���� � ��� " ) <br /> TOTAL SQU• DOTAGE: �I� l 4� <br /> 2ND O 3RD FLOOR: _ ' "t(TqL9 Ate' ,,sii, <br /> 411 It <br /> ESTIMATED CONSTRUCTION COST: a -� t", <br /> QQ�� p+ aA e ® tarp ^ . <br /> (Please round to nearest dollar) -• "* .- ♦ "♦ "♦ $ p o 000 , 4- . , :, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,lallo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Litho ❑Don'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 ..'No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes F2i■lo <br /> APPLICATI MUST BIE <br /> (Continue on ON Back) -*E S-►GN E.►D <br /> 545-112(4108) <br />