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ZONING PERMIT APPLICATION www.countyofdane.com - �-. °P-i°NMEP to Web APp;#n_ <br /> 1PROPERTY`OWNER"INFORMATION _ 1 ,. M_ 3; _Y z:v':g7 U�` =r-e- CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 6 c riti,- .P ,gR/(6.ici • oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,Stta e,Zip) - Deed Restriction;CSM <br /> 9'6 5‘ Duavl/4• L 1/dam /q�yn�y✓ S 5351d Variance(# <br /> HOME PHONE CELPHONE ) <br /> E-MAILADDRESS - <br /> 67 6 " 63 73 t/ Th ' .'/i s�ic__G1 -in co Sit n drawn to scale <br /> A`GENTi1NFORMATIO f ' �" ,� (C_ONTRAGTO 1INFOR TION w y d includes dimensions <br /> _ p <br /> �cn-__.._ _. .._--o=ff+ �Sr•.i�_F = �-..Lam- .,,.��a.,..,.+.r : .:.,3J 3'n� _ <br /> AGENT NAME CONTRACTOR NAME <br /> Et <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) a acks <br /> PHONE PHONE ❑Site proval from <br /> ap . ab township. <br /> E-MAILADDRESS E-MAILADDRESS - - <br /> or plans to scale <br /> PROPERTY/LOCATION .10000A IOM> (httPa/aeeessllane co,dane:wi.usl) 1�- vation of property <br /> PARENT PARCEL NUMBER: .• CURRENTZONIN A EAGE: <br /> ElPARCEL R H -1 '1 ^7 T . ' frontage drawn to scale. <br /> NUMBER O�10 1 301 q 1 00 0 <br /> TOWNSHIP: - SEC ON: <br /> 1 3 / /: 5 F ,/4,/4: 0 Driv w rmits <br /> ci-N / (stat o nty,town) <br /> A RESS: n n <br /> CSM: 3S 1 LOT l0M1 1 o L---) BLOCK/LO - ( I Sa' ita • its <br /> "� - L (Pub'-, • • ate) �0 vTh <br /> ,wr— - - <br /> PROPOSED--PROJECT-INFORMATION:":. - �� STS ;��y. !�`' <br /> PROJECT DESCRIPTION: - ' - <br /> _ bti <br /> e?rte"=-= r'+'._ - _�- a''`-_ <br /> This project is a new building•orstructure. 5 �1 : i d= `4- -- <br /> This project is an addition/alteration to an existing building or structure. �- �. <br /> SANITARY SERVICE PERMIT NUMBER: VT - A, 9.1' F T a_ <br /> EWER EPTIC e " 'w zr`" 1 <br /> HEIGHT IN FEET NUMBER OF STORIES; (Not including basement) ,-- -� �- <br /> . iii.- 4 �=iI ' 1 ��„^ - <br /> `� y��P;� a��•--try te- 4e <br /> AREA TO NEAREST SQUARE FOOT: 4' g t <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ - = <br /> BASEMENT: , : - 1ST F OOR; - � • 1 ---'"� -t— <br /> 1 ,, TOTAL SQUARE FOOTAGE: + o fe_. : q.Ilt- <br /> 2ND FLOOR: 3RD FLOOR: a = -1"' z z : <br /> b 4, Z,�- <br /> J) spa e. -v a J, <br /> • <br /> ESTIMATED CONSTRUCTION COST' y c`Q mTe' h <br /> (Please round to nearest dollar) -4 ♦ ♦ � QQ� _ z - <br /> i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' QNo.• C pon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ONo .QDon't know . <br /> 3. Have you talked with the township about your project and are they in agreement'? Ses ONo. _ •. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes : ,eNo : : . <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) aes n?lo (Don't know <br /> 7. Is this to correct a violation? - Des gNo <br /> • <br /> APPLICATION MUST BE SIGNED <br /> • <br /> • • • - - • (Continue on Back) -► -4 -i. <br /> 545 192{4/09) - <br />