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lig .-7/- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN AME •berT i it is <br /> R <br /> El Zoning Status;C <br /> OWN.R DRESS (Number,Street,City,State,Zip) Deed Re ri ' ;CSM <br /> 75b1 �/ '1" Ass ' read/Sox// GU; 5 3?/9 Variance ) <br /> HOME PHONE CELL HONE / E-MAIL ADDRESS <br /> 4R9`- )6- O7 LA; 11iS'IL'- '►'1ZJ 1 -Co m ❑Site Plan wn scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include ' ensions <br /> AG NT NAME CONTRACTOR NAME <br /> ACX Soh Iu t TasoAi S'ch luTe.-C.e• s-trocfioA) ❑Site PI ' eluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> ofwell/s p <br /> tic <br /> S 16 a`t 9 Ord LE rkd S bag Dead(,id 4 „ <br /> (City, (City, ❑Set s <br /> T&4 10i W i 53 c 77 ?/J ,U1 O s3c77 <br /> PHONE PHONE / Site Plan a • I fr. <br /> 6 d $ 71,1 3 60 7 6D� .52e/260 7 applica.1 • /PI► .. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ta 0 A S ChkrreYe-dhi fructjoU 7-/ •Cetrn `crgou ltl utereowiy nfeNj . ❑Floor plans tale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) l-cam <br /> PARENT PARCEL NUMBER: CU ZO NG: ACREAGE: ❑Elevation of r erty <br /> ❑PARCEL q oa frontage dra n to scale. <br /> NUMBER O(o0$"313'{�It7°'D �(��/� s • <br /> TOWNSHIP: SECTION: <br /> Vero N 4 S''w '/4: S� '/4'/4: ®Drivewa pe <br /> ADDRESS: '/ (state,co ,town) <br /> 17/v csM: r t N 0 oT os-e Rd uBDrv� e -c Na r B tut �anitary permits <br /> ' w p 3 _ a (public,private) � (p�tl"� <br /> PROPOSED PROJECT INFORMATION ;r STAFF� . <br /> PROD CT DESCRIPTION: <br /> C.009+ru c'r P e a) lie en'e d <br /> . a`fhis project is a new building or structure. 0 ., b <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: - � <br /> EWER EPTIC 13 a6l6` Oodo$ <br /> HEIGHT IN FEET I 4 NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions inclu ' g unfinished area,attached garage and above grade decks or porches) a <br /> BASEMENT: 1ST FLOOR: <br /> ai ? 1 37:4 <br /> VVV TOTAL SQUARE FOOTAGE: j ,: 1 bade <br /> 2ND FLOOR: 3RD FLOO n 1,:� <br /> A. n�/� 5yn� Like :: <br /> , -f;Ix 0,110":'''/- - 7 <br /> ESTIMATED CO 1JJ14 <br /> RUC COST: Q / <br /> (Please round to nearest dollar) "'∎ W ly 5) (D 7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? aes • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EINIo <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 o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />