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"--) c . ois -P-SQ 1 / 041 <br /> . ZON?NG PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA/6.. <br /> p`''ct) Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> S "r� P eed Restriction; CSM <br /> HOME PHONE CELL �ON� E-MAIL �M^s / �r Variance(# ) <br /> Or'Z99-0 1! ..• - Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT N24E 4 CONTRACTOR NAME <br /> 440-1/4/LC'D �-7_ -7;P 771.r HoM,to7 ite = including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / • •,ell/s- lc <br /> //1/5-/J( ./464,e �" 4734 �l .�1�.-.1 �J <br /> (City,State,Zip) �� (City,State,Zjp)� ` �35 r etbacks.-->4 <br /> PHONE , ,535-3 PHONE Z( _�� Site proval from <br /> Q��2(�r -� (6a�) 9 , a ' abl ownship. <br /> E-MAILA DRESS E-MAILADDRESS <br /> Her4orics s.lr.o.c•"., -+'o,fi.(r�+ortt)e 44-0,(„,..„ -Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) 1911 _ ation of property <br /> PARENT PARCEL NUMBER: CURRENTZONIN ACREAGE: p p y <br /> ❑ PARCEL © CDc ,00 Q_ - 2.5�} rant-.e drawn to scale. <br /> NUMBER U 1'I 2N-I i ` rl <br /> TOWNSHIP: SECT] ff Drivew. •ermits <br /> Y %<: C '/4%4: S - -,co nty,town) <br /> ADDRESS: 2 ` ( / , <br /> 1-7 cSani -• • mits <br /> CSNY�� S LOT SUBDIVISION BLOCK/LOT (public, • ivate) <br /> ff <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> AC)(3 wy 0 14../6eti ,Pre-k I Zoning District <br /> ❑This project is a new building or structure. • :ermitted Use? <br /> ,This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ��{{ PERMIT NUMBER: <br /> Ru - • ••ress <br /> CI SEWER El SEPTIC / \ (ne'�yxisti :.HEIGHT IN FEET: r NUMBER O STORI S: (Not including basement) <br /> 2.$ Z \ land oodplain/ <br /> attrOhment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> rosin Cont ••I permit <br /> BASEMENT: 1ST FLOOR: C ••ante <br /> J <br /> 4, TOTAL SQUARE FOOTAGE: 4, -y-r"�'-_ , <br /> filling/ac -ss <br /> �a <br /> 2ND FLOOR: 3RD FLOOR: /� y(�' <br /> 1 Review Location Su -.y <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available o tions. � <br /> (Please round to nearest dollar) �. - Q Q r <br /> . - v, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,XNo CI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes M No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes A No <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) CI Yes +�iNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />