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ZONING. PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT*Web4App# <br /> 'PROPERTY:`OWNER'INFORMATION a,:.` _A ;s h t, 4,U0S,4 CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> A SAlc.wReXL-_ ping Status; CUP; <br /> OWNER ADD ESS (Number,Street,City,State,Zi ) <br /> Y Deed Restriction; C S M a '&Cv � t4- MC f o ttlei.„E 6S E , <br /> - Variance(# - ) <br /> HOME PHONE CE L PHONE E-MAIL ADDRESS be . 98 - Cz.\n∎ lW‘✓tkt gv V'cow` <br /> z �,-�S � �,��� -�„r .,� ��,_,.,���. Ite Plan drawn to scale <br /> AGENT'INPORMATIOItI;�",_ - - x� rCONTI ACTO�t 1iiro IgT10N z_ , `" and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site ncluding location <br /> AGENTADDRESS CONTRACTOR ADDR S of w ptic <br /> (City,State,Zip) (City,State,Zi aCICs <br /> PHONE PHONE O Site P royal from <br /> - applic township. <br /> E-MAILADDRESS E-MAILADDRESS • <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORI)AA' (OM> (http,l/aeeess!ane co,dan_e 1.as/) ; -a`; ation of property <br /> PARENT PARCEL NUMBER: CU RENT ZONING: ACREAGE: p P rty <br /> OPARCEL 0/� �`� frontage drawn to scale. <br /> NUMBER ()QC) t)4 / ?iS I - - <br /> TOWNSHIP: - SECTION: <br /> Ill\23, \1\.\C\ 'A: %IA: Drive permits <br /> ( , ounty, town) <br /> ADDRESS: I ie�' °j� ►P (°"+"1n - ❑Sani■- •-nits CSM: LOT 1 SUBDIVISION BLOCK/LOT <br /> (p■• 1•, private) <br /> PROPOSED PROJECT_INFORMATION <br /> �5T� R1�I�� <br /> Ir <br /> PROJECT DESCRIPTION: <br /> t /e^�� " a `' • - <br /> A . C.._' .d. Sg XS L ii e a Dl rie ,y <br /> r�4s4.--` '�F "eta - <br /> OThis project is a new uilding or-structure. 7 '" ''° t Ire; <br /> 1d Te : idis "-� ;; <br /> This project is an addition/alteration to an existing building or structure. '.` .. -= - <br /> SAN ARY SERVICE: PERMIT N B i F a e e5 t_ <br /> EWER . EPT1C 6 41,-. - <br /> HEIGHT IN FE NUMBER OF ST !ES: (Not including basement) f ¢ -��, 'y <br /> '° ?� <br /> AREA TO NEAREST SQUARE F OT: ' i` - - _-t <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) s 'al . <br /> BASEMENT: 1ST FLOOR: • � e <br /> TOTAL SQUARE FOOTAGE: 6 <br /> 2ND FLOOR: 3RD FLOOR: ,M� .. <br /> ESTIMATED CONSTRUCTION COST, . .F -° ' <br /> (Please round to nearest dollar) "♦ :-+ --∎ '-+ ""I• "I> $ 1� 3 aim '° , . _:v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? U es ' ONo.- ODon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ONo .ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? OYes QNo. - <br /> •4. Has there been a zoning permit issued for this property in the past 5 years? OYes ONO <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 ONo ['Don't know <br /> 7. Is this to correct.a violation? [Yes ONo <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —1.- <br /> 545-112-(4/08) - <br />