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. . . )0 / 4 <br /> " ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER;:INFORMATION f,,;,:: _. _' `,h ,4 i,tVi,,, =,_: ,,5 -st; <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> LI ■1715 0 L" 1—(2. c,-,r .6,,r_ '"Zonin Status CUP <br /> OWNER ADDRESS (Number Street,pity,State,Zip) <br /> g <br /> U Deed Restriction;CSM <br /> s 3S P-O`�)°S � C / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 <br /> 4 \ ite Plan drawn to scale <br /> AGENT INFORMATION ;;:• CONTRACTOR INFORMATION t d includes dimensions <br /> AGENT NAME I / CONTRACTOR NAME <br /> �E'Gvi`�I? J (d(� ite Plan including location <br /> AGENT ADDRESS CONTRACTO- •0=-ESS /f well/septic <br /> (City,State,Zip) 4) r (City,State,Zip) I• etbacks <br /> PfjUNEO 6 -7 70 PHONE e Site Plan approval from <br /> //��JJ" applicable township: <br /> E I L ADDRESS , / E-MAIL ADDRESS <br /> I .eje (1 a O 4 l r/ _.r m. loor plans to scale <br /> PROPtERTY/LOCATION;INFORMATION :;(http:llaccessdane.codane.wi.usn;; Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: P P y <br /> Li NUM ER % , Q � ��c i CO • _ . J G- frontage drawn to scale. <br /> TOWNSHIP: SECTION: _ <br /> T", c,c id _�'/a: 'v. E %,z_s f 1.7. Driveway permits <br /> ADDRESS: state,county,town) <br /> 11 -anitary permits <br /> CSM: LOT SUBDIVI ION (Vt7�/'`� BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION S - " TA �' :' <br /> PROJECT DESCRIPTION: t-z� t - � `';. <br /> �C)C Gil 2 `C C1 v/c�)1 �` A.t� r _? ' " <br /> ■ <br /> CI This project is a new building or structure. E ,ii,' <br /> his project is an addition/alteration to an existing building or structure. -' .' ' ! ' <br /> SANITARY SERVICE: PERMIT NU - al r°ir �:' ...,,`'"-• <br /> i <br /> ❑SEWER 1► 'TIC <br /> "� g # i frd <br /> HEIGHT IN FEET: NUMBER OF STORI5 S: (Not including basement) 01:::°.I-=';4•1:-L-� . '•e s� £ Y :, <br /> i :i <br /> AREA TO NEAREST SQUARE FOOT: .,,� : <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) l .4- . `� <br /> BASEMENT: 1ST FLOOR: �3 it p_:tir, , 7' <br /> /'i 5 4 TOTAL SQUARE FOOTAGE: 1 � t ;��:p„je, s , ' <br /> �OO ' ,. <br /> 2ND FLOOR: 3RD FLOOR: . Q'•-•:-..i <br /> ESTIMATED CONSTRUCTION COST: -► ap , g 90@ <br /> (Please round to nearest dollar) $ i O O Q � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ■lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ■ 10 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ' 'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No 't3 Q 0'70. _... <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 lo ❑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 />