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. . � <br /> hos 9-1--- <br /> ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App#. <br /> PROPERTY OWNER1NFORMATION .. ,,Y,� g4,, .x, `' <br /> --it E CUSTOMER TO PROVIDE <br /> `&;) in 1 a Zoning Status;CUP; <br /> 1- OWNER ADDRESS umber,Street,City,State,Zip) <br /> D e est ' <br /> ctlon;CSM <br /> ` a3 5 oh _kc} G -rr � Ao1 (A ( 53s7_ Variance(# <br /> )%--.,/,,HOME C NE , D R r <br /> Vo8 -rar 1.••$ 3 --75R • A / 4, .. .0. S 'te PI wn to scale <br /> AGENT INFORMATION:;:; CONTRACTOR INFORMATION s a • dudes dimensions <br /> 1-AGENT NAME CONTRACTOR NAME <br /> CA/k 4-Ra.0,'I 6.y. 6Lk; l d.Ys 0 •e Pla ' uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of septic <br /> f ti8es TradPw;kk kvekW s,„;---p a6p El et <br /> \ /�(City,State,Zips) (Ca State,Zip) S <br /> i✓6Nd . o2,, ki/ 53719 <br /> V HONE / PHONE J Sit Ian a val from <br /> (4°C) 6/ appl' a township: <br /> E-MAILAD R SS <br /> I E-MAIL ADDRESS <br /> /• , 0 Ir.. . • ^1^.. a . .J.. <br /> oor ns to scale <br /> PROPERTY/LOCATION INFORMATION '.(http://accessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: �y(� C� CURRENT ZONIN ACREAGE: Ievatto. • perry <br /> ❑ PARCEL I� ! 2 7 3 \V \ _ I 15•4_,5 —0..•. - to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: / Driveway�p} ) ✓� 1/: 5.� A. /1 y permits <br /> DARE j ���`^ (state,county,to, • <br /> ADD SS: <br /> ,i 4 �.4r :r S. itary•ai--- COO <br /> CSM: LOT IF SUBDIVISION BLOCK/LOT (p 'II .rivate) <br /> PROPOSED PROJECT INFORMATION, - <br /> PROJECT DE CRIPTIO ÷ -_. y x <br /> � �Ong/e, ,vn ► t <br /> This project is a new buiteing or structure. - <br /> ❑This project is an addition/alteration to an existing building or structure. kr = 4 43= <br /> SANITARY SERVICE: �/ PERM T NUMBER: pi-7404461.1 - 1 <br /> ❑SEWER 'NJ SEPTIC / C6 ) 11'1 $, e91 <br /> HEIGHT IN FEET /I 1 NUMBER OF STORIES: (Not including basement) -r - s 7¢ 7- <br /> AREA TO NEAREST SQUARE FOOT: �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . : 4g <br /> BASEMENT: 1ST FLOOR: T e .. e e 1-1,, I <br /> 3 4, TOTAL SQUARE FOOTAGE: j s ,, <br /> 2ND LOOR: ' 1 3RD FLOOR: , :�� <br /> ES IMATED CONSTRUCTION COST CO ,re�� a. 1 <br /> (Please round to nearest dollar) "■ "� "■ 6�CI U/'yrj ° S. ` S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes '"No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'Ef No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? BYes ❑,��o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes i 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) ❑l-es ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes 'VI No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />