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ZONING PERMIT APPLICATION <br /> WWW,countyOfdane,COnl UPPL'EMENTIto Web•App ? <br /> PROPERTY OWNER"INFORMATION • `- ;, .� F <br /> OWNER NAME <br /> .. -.. 5 �x ,sn s <br /> /-re.c,/ CUSTOMER TO PROVIDE <br /> KB WNER ADDRESS d4 rSt ON <br /> (Number,Str et City State,Zip) ••�`b G/ ,� �° Status; CUP; <br /> HOME PHONE `L PHONE <br /> /L Zeed Restriction; CSM <br /> LL PHONE ��' 1..0.,z-- 3je'�� <br /> Gee�B%4//1 E-MAIL DRESS Variance <br /> %AGENT�INFORMATIQ111, '�_ �'c'�wry c r /p,3.? � _ ) <br /> E CONT /!7a>/io•09. S. <br /> AGE E 5 t t6 I ACTO�try1NFOR z t- : . n drawn to scale <br /> / CONTRA T R NAME _/, <br /> and includes dimensions <br /> AGENT c/0 _ Zw !- <br /> ADDRESS �e o �v���//� <br /> �� Alf; / CONTRACTOR A �" '� e Plan including location <br /> ih/,State,Zip) - h� � o of w eptic <br /> 1cr�+)1, �L �ta/9 (City,St ,Zip) ° <br /> PHONE [1 etbaclCS <br /> 8 ?�,O�a-S° PHONE <br /> E-M ADDRE S Z� ~�y,•5=9�d� Site n pproval from <br /> /S�_ / E-M ILADDRESS aP lIC e township. <br /> ZCo ! �c.f. / <br /> PROPER /LOCATIuN I FO Le`?l w/e-O • aji"),13 ` ,`� gy/toor s to scale <br /> t. R 4TtON; bttp.//accessdane.c i4*6 :gig/) <br /> PARENT PARCEL NUMBER: <br /> 0PARCEL CURR TZ NING; a 'Elm'' <br /> NUMBER �'1:� ��� "�� v /� vation of property <br /> TOWNSHIP: rontage drawn to scale. <br /> • <br /> 4/6),:w. SECTION: <br />/ ADDRESS: <br /> �� � � _ '/a'/<:_ _ the permits <br /> CSM: �= t,:1,l, A, /'.�! (St C nry, town) <br /> LOT �-`���- ��.� <br /> �64eo - SUBDIVISION atilt <br /> BLOCK/LOT rmits No <br /> PROPOSED PROJECT. INFORMATION. (publ , 'vete) <br /> PROJECT DESCRIPTION <br /> IN his project is a new building or structure. <br /> QThis project is an addition/alteration to an existing building or structure Itt '. <br /> 4 <br /> SANITARY SERVICE: 'gym{ d' , <br /> - I.EWER p � �T�'�t ���• ' <br /> e s, <br /> NUMBER OF ' ,. 4, } <br /> F STORIES: (Not including basement) E F"'' <br /> AREA TO NEAREST SQUARE FOOT. : °Z-OCP° <br />(Outside g I�I�° Af ,,( <br /> e dimensions including unfinished .« )1.0 ` ` l6�ij <br /> BASEMENT area attached garages and above grade decks or porches ,e• 1ST FLOOR: / -t 'g' <br /> <� 3 TOTAL ) __ ,',•D a ;pr • °e, t _• 4-;./: <br /> 2ND FLOOR: SQUARE FOOTAGE: a <br /> 3RD FLOOR: ��j�j���.`.�y � � j�k <br /> ESTIMATED CONSTRUCTION COST, ��� 1 w `*" <br />(Please round to nearest dollar) We �,y\�_l(J, <br /> -► ♦ -4. <br /> • <br /> The grope is 4; _ C. <br /> rty 's within 300 feet of a stream or 1000 feet from a pond or lake? V <br /> Is there a wetland or floodplain on or near the property? <br /> []Yes [Don't-know <br /> Have you talked with the township about your project and are they in agreement?.... f--�,� <br /> 0 <br /> •�•�•�••'•"' u`� . � QDon't know . <br /> Has there been a zoning permit issued <br /> �o. <br /> • d for this property In the past 5 years?....••,•,. <br /> Is this project associated with a rezone/CUP/Variance(petition/appeal(P #____________) e5 • ONO : . <br /> s a location survey required? (see reverse)..............• ppeal (leave blank if one) � • <br /> s this to i o survey <br /> violation? ..........•'•" <br /> o []Dori't know <br /> .......................................... <br /> - <br /> 2{4/08) APPLICATION MUST BE SIGNED <br /> (Continue on Back) •-. --1. --f <br /> • <br />