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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App# <br /> PROPERTY OWNER.INFORMATION z, : .K =_ ,W.L.f4:. AW.:„;: =._- `.,-P1_-`,:; C STOMER TO PROVIDE <br /> OWNER NAME / <br /> AA <br /> L uu i ii `1 III;c '^0• - / ,:./se I' Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stpte,Zip) <br /> -� • eed Restriction;CSM <br /> / .37 EGt!, a$ /�1 / ill / c -e / vi ' ..3S , Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6,e 1i 77- 6e7 le -S-27-6617 f11:c46e /, .(1,0;,F,- Me).y( : ( c.1 <br /> /- � S'e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION.: .',:, ',-1.-:=,:: nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SG Li 1E-- C f t'4-11r Ye /,o, / `\ ie Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS If well/septic <br /> p (:), ,8 CA' • b 7 <br /> (City.State,Zip) (City,State,Zip) Setbacks <br /> i"l7u/- >i„/ &0'I 7 <br /> rs s <br /> PHONE PHONE ❑ ite Plan proval from <br /> ■c , S _ -- to 75 plic e township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION :(http://accessdane.co.dane.wLusn;: levation <br /> of property <br /> rtY PARENT PARCEL NUMBER: CURRENT ZON,iNG: . ACREAGE: <br /> ❑ V ( c 7" 6 J' //e D NUMBER I <br /> C r ntage drawn to scale. <br /> TOWNSHIP: ,�} SECTION• �( p <br /> 5f ;-'n 6 Dole_ cal 1A: 4)1,0 1/41/4: 1l i�� riveway permits <br /> ADDRESS' state,county,town) <br /> aizo >a r n <br /> C P A V e I- /t q S:nitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT •UbIIC,private) <br /> it t ( .7 / .N ,,q p ) <br /> PROPOSED PROJECT INFORMATION "PROJECT DESCRIPTION: I ' • A� ��R <br /> A.//e /- /- - of 'e d c p e fC L ?��f s ` <br /> Ecrhis project is a new building or structure. - Q <br /> � 4 L_ e R a <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> � A,SANITARY SERVICE: PERMIT NUMBER: : �T Aa � <br /> '`It- <br /> ❑SEWER L7 SEPTIC ' f 8 7j r � L`=ti. ,'� a <br /> HEIGHT IN FEET / ^ NUMBER OF STORIES:,(Not including basement) <br /> /AREA TO NEAREST SQUARE FOOT: ,.� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) " '' ' <br /> BASEMENT: 1ST FLOOR: <br /> F'47 r 4, TOTAL SQUARE FOOTAGE: s_ .? t I <br /> 2ND FLOG 3RD FLOOR: <br /> 7 <br /> F � <br /> ESTIMATED CONSTRUCTION COST i ' ( <br /> (Please round to nearest dollar) ��, CI ��z- �, � 7, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes C3 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? aces ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) / <br /> 6. Is a location survey required? (see reverse) CI Yes No Don't know <br /> 7. Is this to correct a violation? ❑Yes 2No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —o. <br /> 545.112(4/08) <br />