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ZONING PERMIT APPLICATION www.countyofdane.com 'rSUPP,�EMENT to�Web•App# <br /> .%: '.- OWN _.:-.'-..IN.,O_.MA ION ' <<a,:`..;7;:;r - : "}Kt` W=; _._-:-'4rj:t Z_ CUSTOMER TO PROVIDE <br /> OVER NAME iN V V • <br /> K 4-Oiini< .1PC B E- <br /> ivi Zoning Status; CUP; <br /> O N E R A D D RES um b er,Street,City,ty,Sfate,Zip) • <br /> 2z I O E CR STreGCTi I C <br /> 0Pl Deed Restriction, CSM <br /> • Variance(# - . _.. ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 115-36q- 22g-3 -1/44 57' 3C ,___^ , Site Plan drawn to scale <br /> AGENtIINFORMATION=R t `' -`s z. i..°° ° T-�-,R� '4` "� <br /> .,_ .. _-�_:.�? -:;r;:`��1CONTI�ACTOf:INFORi�I/#TION__, z.�_, ,aZ and includes dimensions _ <br /> AGENT NA CONTRACTOR NAM <br /> 1•1►dIq.icm 00,,,,PSc� U.-s.r.n.% E <br /> tpest J(C Site Plan including location <br /> AGEpLT D RESS CONTRACTOR ADDRESS V of well/septic <br /> J r.3"Q ICY rri 7{-., Si s- o Lt'x%hi •S' <br /> (Ciry, to z ) > (ci to ) IA Setbacks <br /> 1 <br /> PHONE PHONE VI Site Plan approval from <br /> jog- g3P' /11Q 6p� —S5; 3/110 . . applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS - • <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION>.(htip.Uaccessiane.co,dane:vin.us/) . _- <br /> PARENT PARCE}NUMBER: CURRENT-ZONING: . ACREAGE: i Elevation of property <br /> El NUM ER 042 gl'os-36Z" c•�i7-(� 1 � ` Z. 02 frontage drawn to scale. <br /> TOWNSHIP: !n tl SECTION;3C <br /> ()(ii V- e'er/4 S e '/a: Std '/4'/4:71 ?g Driveway permits <br /> ADDRESS (state, county,town) <br /> Git 9� e� 0 ` <br /> i I �� 10 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 12Q 6 (public, private) <br /> PROPOSED PROJECT INFORMATION " . - . . 5a TrF:IRRiEVIIE, -A <br /> PROJECT DESCRIPTION: <br /> oral a _ � <br /> = x � F <br /> . his project is a new building or-structure. rek.Mgr, . ' ' <br /> This project is an addition/alteration to an existing building or structure. -. <br /> SANITARY SERVICE: PERMIT NUMBER: 9 . _ <br /> ".ems 6'„ - <br /> EWER . I '•EPT1C J." 6 <br /> HEIGHT IN FEET , NUMBER OF STORIES: (Not including basement) i k', - 's <br /> Q � _ !u W 0 eke o I <br /> .:: 11.6 z ate � <br /> AREA TO NEAREST SQUARE FOOT: �' l.` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �,- <br /> BASEMENT 1ST FLOOR: r . 6�1gR/4F+•c �``�•O p§ e r• ���T 4, TOTAL SQUARE FOOTAGE: � ' <br /> 2ND FLOOR: f 3RD FLOOR -_';�ilti-._ ar t �t�rr->. `�i g iv/h <br /> ESTIMATED CONSTRUCTION COST " <br /> • ■" ■ ♦ $ !r47 7 00� o0 , F E <br /> Please round to nearest dollar <br /> • 43`7x.& • - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or la e? []Yes ' /0 o.• [ Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ]Yes ►: • EDon't know . <br /> 3. Have you talked with the township about your project and are they in agreement? .0'es o. - . <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? EYes No - . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave b ank if none) <br /> • 6. Is a location survey required? (see reverse) QYes 1211 o • fDon't know <br /> 7. Is this to correct a violation? V EYes ATM o . <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 54S-1120/m) - <br />