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UP LEM taofWeb RP ZONING PERMIT APPLICATION ww.countyofdane.corn - - � N <br /> ,ROPERTY OWNERINFO�RMATIOv " = _ _ ` <br /> - N � ��� ,3�_��•_ :='a�:;.:.5_�Ni.��"_ :�i�r=.�" CUSTI"®MER TO PROVIDE • <br /> OWNER NAME ' <br /> c4Pve ti Li' r,be I I Zoning Status; CUP; <br /> / 4t' <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - Deed Restriction; CSM <br /> Zoe' 4 oak_ -v c _ - ik`'JCff LIT 5-3 r?7 • Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> o 9,./y-s-7/ c , riiit c-Lta..:c'4t 41- I I Site Plan drawn to scale <br /> !4GENT�IINFORMATIOInI P-Mt ,.5r;; ;CONTACTOIiiCoi:{1 TION_- 1 and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (city,State,Zip) (City,State,Zip) I I Setbacks <br /> PHONE PHONE n Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - • <br /> n Floor plans to scale <br /> `4PROPERTY/LO_CATION IMFOjtUtibM (http%/aecesstane eli****Ii I) :- <br /> PARENT PARCEL NUMBER: . CURRENT ZONING: ACREAGE: I I Elevation of property <br /> 0 NUMBER 0I 1/-232-C147/Se/7 C Z frontage drawn to scale. <br /> TOWNSHIP: - SECTION: <br /> 23 ,/: ,/4,/4. n Driveway permits <br /> ADDRESS: (state, county,town) <br /> 7073 e-41(t, ZezKF 5.0 /' `vsiF &.T n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ' _ (public, private) . <br /> PROPOSED PROJECT INFORMATION -r = w1 SY KERiV <br /> PROJECT DESCRIPTION: :rE _ <br /> Sf i' 12.1 X ZS Nff-494 6uW j L4''� C►'bt't-P tini7 ehIS IIC '' <br /> J 7- - <br /> . its project is a new building.or-structure. 4 <br /> nThis project is an addition/alteration to an existing building or structure. e__.: _ .. t <br /> SANITARY SERVICE: PERMITNUMBERC f �{EWER . 1EPT1Cb s:,} �° <br /> n`• -:m <br /> HEIGHT IN FEET: NUMBER OF STORIES; (Not including basement) 4",---;.:;-,_ � ��-- —_; <br /> l I / Q1-tE1al0 Iocd1:I8a1 <br /> I PSe�lf . a -e <br /> AREA TO NEAREST SQUARE FOOT �__ ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) - > ^° <br /> BASEMENT, • 1ST FLOOR: D e•S �� r R <br /> '3 j 2 ' J TOTAL SQUARE FOOTAGE: .I `Z.,_ '-,C1-124a.,?,, 5 SftL�T68 a1;1l j= <br /> � 3 <br /> 2ND FLOOR:R: 3RD FLOOR - 5� � 1 ~_ <br /> 2 - <br /> ESTIMATED CONSTRUCTION COST: n + e e <br /> (Please round to nearest dollar) --� -•► --► -* -∎ "� 5-00. — - - _*------',...11 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake'? I]Yes RSIo.' QDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes Eircio .ODon't know . <br /> 3. Have you talked with the township about your project and are they in agreement'? [ Yes RIcTo . . _ <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? [r/Yes QIQ"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) - Efres gKro QDon't know <br /> 7. Is this to correct a violation? QYes 0140 <br /> - APPLICATION MUST BE SIGNED <br /> • - (Continue on Back) .+ -► . <br /> 54S-112{4/Da) - <br />