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SLIP!,L�ENIENT,rito3Wewri <br /> ZONING PERMIT APPLICATION www.countyofdane.com - . <br /> 401OPRTY_ OWNR INF,OA MAION - '_S " ',.. ii CUST OME R T- O PROVIDE NAME <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - Deed Restrictiop5 SM <br /> 9 2 L'1ict) - kJ - . 1 , - . T '`3S`. Variance(# I`N'f ) <br /> HOME PHONE CELL PHONE E-MAILADDRE'r <br /> b1CFC s-76,-6 9I • d C:• pct M(44 r C' rdSite Plan drawn to scale <br /> AGENTi1ORMAT 10 n1R 5Hr r�0 T 0.CTO VI"N E:R ge lrON �M <br /> �' <br /> and includes dimensions <br /> AGENT NAME CONTRACTOR <br /> NAME <br /> 1-07Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) [etbackS <br /> PHONE PHONE ' V' Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - . <br /> • Floor plans to scale <br /> `PROP RTY/COC'ATION 1fiTto tMt(OTQlitieia/aecessritib:T dal t is irj <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: �levation of property <br /> pi PARCEL NUMBER O`W/Q O/2"(74D��-%3rrJ_ 2 "Q N ) ..3,*3 frontage drawn to scale. <br /> TOWNSHIP: . V SECTION: <br /> • <br /> CRS%- tom, 1/: . ,,. [ riveway permits <br /> ADDRESS: (st te, county, town) <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public private) <br /> PROPOSED PROJECT INFORMATION. : i ,;,•F°' r Y_ , = 4 l <br /> PROJECT DESCRIPTION: i . t� <br /> 2/� a/�G �aa-/Ace_ -tom as rlc �,, , <br /> This project is a new building.or-structure. - 1;431.----i-i-.797—;--% - <br /> ;., errnittedEC7se V <br /> [1This project is an addition/alteration to an existing building or structure. , . s <br /> SANITARY SERVICE PERMIT NUMBER: ei ,g • ' a1C-es5' :0,i z <br /> ,i -i-s. .ate_._k z v <br /> . FIEWER . PEPTIC - ^ W,B Ss gi 5` G <br /> HEIGHT IN FEET: <br /> t NUMBER OF STORIES: (Not including basement) r 7�- � - F• <br /> VIP ali �'_itac ,e � <br /> AREA TO NEAREST SQUARE FOOT: = <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) " , - �` <br /> BASEMENT; l g --'!v. 1ST FLOOR: D-Q ' r� P� 3 <br /> :j. TOTAL SQUARE FOOTAGE: 4 s o 0E__5 BLS L'`1T6 gP ? f NIA <br /> L 00 :V �� c ACC S� IZ <br /> 2ND FLOOR: 3RD FLOOR: _ Y_ <br /> •, <br /> . . • = _ _" -. <br /> • <br /> ESTIMATED CONSTRUCTION COST: p � e E i v <br /> (Please found to nearest dollar) '♦ '♦ '0. 4 "4 "� $ V )06 =—� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? OYes-' ©No-- ODon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes EN .ODon't know - <br /> 3. Have you talked with the township about your project and are they in agreement'? Wes ONo. . - _ <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? es : o ' <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) Oyes ®No V ODon't know <br /> 7. Is this to correct a violation? V OYes ONo <br /> - APPLICATION MUST BE SIGNED <br /> say-112(0N8) <br /> - • (Continue on Back) . —► —+ —O <br /> • <br />