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,;;SUPPLEMENT to.Net0100 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION , .r.,._'r, . .' ./:-. CUSTOMER TO PROVIDE <br /> OWNER NAME • . <br /> Jam 'W - C('t,- .\K1I n . ❑Zoning Status; CUP; <br /> OWNER �ESS (timber,Street,City,State, Deed Restriction; CSM <br /> `/It B ` Jordan Dr. Variance(# ) <br /> HOME PHONE CEL. PHONE E-MAIL ADDRESS <br /> (;08 L(7--X250 rconkltn IS®rne•aorn <br /> ❑ Site Plan drawn to scale <br /> AGENT'INFORMAT ION ? • , 3 ,CONTRACTOR:INFORMATION i and includes dimensions <br /> AGENT NAME CONTTAC oR NAME}i-1 <br /> C604 4'6IIL'" ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • of well/septic <br /> 16t w �,�+we_ S <br /> (City,State,Zip) (City,State,Zip) �� �����' ❑Setbacks <br /> PHONE PHONE ,�� ❑Site Plan approval from <br /> beg- 577,_7NI applicable township. <br /> / AILADDRESS E-MAILADDRES vv�// <br /> ,� �0evi4Y dtpA 2 Z Do,GOw ❑ Floor plans to scale <br /> 1 PROPERTY/LOCATION„INFORMATION i.,(httpNlaccessd e.eo,da, .e. i.I.si) , = ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> LI NUMBER 06/o cris4 5,46)--01 R^3 --).- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> v ekiN '/4: C IRA: ❑ Driveway permits <br /> (state, county, town) <br /> ADDR 3 G o .so pd ow, o r <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION L i'Z , ST�F tzREIIE1W <br /> = }PROJECT DESCRIPTION: � �V� �4 �S 7 �6 Y- � F : r x <br /> i� ng Dlfrac �� <br /> ilea R-'N'. J <br /> This project is a new building or structure. © perm tted'Us�� <br /> This project is an addition/alteration to an existing building or structure. _ 1 <br /> tx L _ <br /> SANITARY SERVICE: PERMIT NUMBER: il' AilraIrAddress, ,,A j <br /> [)EWER r)EPTIC �e ilAt Xts I J�5 ^t}r� rt <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) '- 1, t. <br /> hWetlatidifi oos)plaiti l <br /> . = ShO>•'e"land�iattacimept)= <br /> AREA TO NEAREST SQUARE FOOT i jam' - ' <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) u�gi.t i" . <br /> 1-CostorICo l pertelt-� <br /> r' ..row -• '�,F',:f^'"'` -. <br /> BASEMENT 1ST FLOOR: yr� ��..� �.6 <br /> 4 , TOTAL SQUARE FOOTAGE I `.e ]apes b ISturbB ce, <br /> 2ND FLOOR: 3RD FLOOR: 4%4 ;,��, T <br /> LS �. e <br /> -"rte 45 <br /> ESTIMATED CONSTRUCTION COST: �S1 O- -1 ..'i:LoEEO- ueey. <br /> �1v�N�' /1 + d, agabje ptTOVIS :4, <br /> (Please round to nearest dollar) ♦ "'� '� � �Vl 3 = " - 69'~. F1_ f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ❑No • ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? III es !�No _❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes. o _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies '1;1 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) ❑Yes II►o . Q Don't know <br /> 7. Is this to correct.a violation? Des rg k o N-.''' ) NW ' <br /> �i APPLICATION MUST BE SIGNED\ . <br /> De.f, ` '-' "' (Continue on Back) -► _0.545-112{4/oa) <br /> I'Le. I'V'6, -\. 1. Odel. 40 • ti65hwi, <br />