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. -73 5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a/rr■.e/u-cam '1V— C`'-IiLr` f ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1/° / i •a tit, 64-4-(7( -7d1Ple - c--e vr7-)&i L - / Variance(# )• <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> it Li, 4' S33 8,1-7 U? . J :SCC' ,.s/a&M-nV(1Gtf vicvr.'7d V- cinil ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,/.i 2 6 Lyel (yd / //'1 yd . (24t ca-cr. . /,L9&.LQL2 - ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 30 C il led LS14-4; /) 5Zr5- ..iii9-(//dif Lye+, ; h 6 <br /> (City,State,Zip) (City,eState,Zip) y j� {d ❑ Setbacks <br /> PHONE e�# " a come s- ,Lye.CD' `" �'X �y"GUD S <br /> PHONE a ❑ Site Plan approval from <br /> /"' V0 3 3io 3 1 .-/ 7 ‘78 l" C"863 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /.fit. • y ,i 0,0; a.),; e CPn'J ; [0a, - *.t, oL`il?21e53 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danrr.v4Lusl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL . 7/C -- c r ,-i, ..4- C - frontage drawn to scale. <br /> NUMBER �`// — �CX-� � <br /> TOWNSHIP: SECTION: <br /> 13 Le- — �e�- i e1.,� �-1 1A: Ai L-7- IA IA: vLl ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 36a "- 'i 2- ,c0,(9L0L <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> /a(a "5 <br /> PROPOSED PROJECT INFORMATION <br /> #1�> .. <br /> PROJECT DESCRIPTION: U, ,;K f� -_�-y �yV4L %,,,4*.,. <br /> ❑This project is a new building or structure. y tt , <br /> ❑ 'et'. at t c#�k sue'. ,4, ,,,a <br /> This project is an addition/alteration to an existing building or structure. e - <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address - 3 <br /> O SEWER ❑SEPTIC (r)ewle i ) ° <br /> HEIGHT IN FEET - NUMBER OF STORIES: (Not including basement) a r t <br /> ❑ etjA ,lseIT s e" <br /> 'V� �-,ye a <br /> AREA TO NEAREST SQUARE FOOT: "�: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ‘viii °' �� l: <br /> BASEMENT: 1ST FLOOR: <br /> .3._ <br /> � � <br /> TOTAL SQUARE FOOTAGE: j °�. a� .� <br /> $ k , <br /> 2ND FLOOR: 3RD FLOOR: <br /> i1 ie r <br /> ESTIMATED CONSTRUCTION COST: , cJ n <br /> (Please dollar) -► -► -► -� 5 C�C G .� .1 e e2 <br /> Please round to nearest dollar 3- / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> Li <br /> o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? SiYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? N Yes ❑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) ❑Yes f'1 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes INo <br /> N J APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ -► -► <br />