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I('� 4ti e°A C4-- Lob fr-___ <br /> rte-e_3 _ <br /> 1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com () �) ,-1 <br /> PROPERTY OWNER INFORMATION /" v / vU v <br /> OWNER NAME <br /> ,i\7w .$.IUVes—roit-NTS LLC, Lfl"n.e 3'3/"°�I <br /> OWNER ADDRESS (Number,Street,City,State,Zip) l' IC 11 iM 0 k S Sill.et t ) -00,c k t:.A yr I+ ) w T 5 3 5 j' ii <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS --�'� 7 <br /> i� ?1k0'1-3y2 kl III X111- / <br /> AGENT INFORMATION CONTRACTOR INFORMATION Ab 4,•...:1-10iZ. <br /> AGENT NAME A E.1_titT Poft, v1610 1 7- I' - CONTRACTOR NAME <br /> Q DO\Ct•U UOt 4- (-E./40 4 140V+s;,ea, L� (1. ?-1% �� <br /> AGENTTADDRESS ' CONTRACTOR ADDRESS <br /> ??18 c-ozSgN, i,■,,vr <br /> (City,State,Zip) (City,State,Zip) <br /> ST,LOV i S <br /> PHONE PHONE Site Plan approval from <br /> 19 ..--1-1.(0 - b 1 O applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I) 1�Ci..-AIU ��wlevikk�oiL.1 4 vi DV+.t 2',um 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE atlevation of property <br /> u PARCEL Oio0rU-1 oto-Q.A--'67.4M5.[ n -I �x /1 frontage drawn to scale. <br /> NUMBER 0100/(Y7 t]LA-i3z gone 0 �-} <br /> TOWNSHIP:NSHIP: SECTION: <br /> ,V E SZ IM U A- 13 .1/4: /. (A) %IA: m cL7'6riveway permits <br /> ADDRESS: (state,county,town) <br /> L O A D % 5 >= it b(3 ( ept ,R`w C K €(9RT H )UU I S 3 S 1 S LI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 0-v l (- TOW&R - V R raiN iAl16Z el e SS ❑ Zoning District I CC to A2- <br /> . ©This project is a new building or structure. LI Permitted Use? `ezclie <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 160' ❑ Wetland/Floodplain/ <br /> (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit ] <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ -► ♦ ♦ ♦ ♦ 41,:,Obe <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L31Cro ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes l i10 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? L3Ses ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 12'(Jo <br /> 5. Is this project associated with a rezone/CUP/varianc (petitio)ippeal#100 10 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) La/es ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Lilo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 545-112(4/08) <br />