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-73�a'7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME _ • <br /> V ' W 0 � ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> I S-15' f c l 64-0-t ` ,c.wTh( 1.4."1- /(— Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 81 1 -7 Ole /144- EN 770 co 1145 4.z),'7.mvPSCUei-rteelWireltSS c(-,13 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> l--r' cik P1f 6 e-nk-- C_°r'cd-cei. cU t ..6.. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5U-S- 4101- 2d' C 5-0 SC ' --Rd oSA-cl.T - 8 i <br /> (City,State,Zip) (City,State,Zip) _ Li Setbacks <br /> ry 11 .�„i�,� /'4z�rL�,� i 1. Co c'0 U S i44All i c L °COc) <br /> PHONE ZJ PHONE ❑ Site Plan approval from <br /> -/0 , Liu 3 3 (O3 gj 41 q'6 I 0 8 0 3 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /be-4MQ.CCV1 c✓dhuWi'PeieSS (D*71 jm&trJa IC.eriel Cc✓acc i& 'eIesS.coi-r- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wius/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL p _0707-35V—g280-S Cols frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Driveway permits <br /> c TWO 6 J v5 Ya: 5E %IA: ,. A.) y p <br /> ADDRESS: 1 �, <br /> (state,county,town) <br /> �}qa I � � ❑ Sanitary permits <br /> CSM: LOT suBDlvls BLOCK/LOT <br /> / (public, private) <br /> PROPOSED PROJECT INFORMATION STAF R VIEW <br /> PROJECT DESCRIPTION: -G,1-) 735-m11-o4-"^24 � JGL, <br /> O bs� CJ?T hdiLt/32 V Zoning C� x <br /> ❑This project is a new building or structure. <br /> ❑ Perr0 <br /> CI,This project is an addition/alteration to an existing building or structure. h <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuraA fdt - gs <br /> ❑SEWER ❑SEPTIC (ne 1j I . <br /> 'HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> U wely <br /> � s a i ° <br /> ' 1 Sho± _ e ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1STFLOOR: � . t ",' � ",' <br /> TOTAL SQUARE FOOTAGE: 1 E. �_ f 1 <) ,mo t <br /> 2ND FLOOR: 3RD FLOOR: � E <br /> zP� k <br /> Li Review L ,' <br /> ESTIMATED CONSTRUCTION COST: �+ d <br /> (Please round to nearest dollar) "� '� "� "� �p `E��UvC� <br /> ..... .::. . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? El Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 113.No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes El No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑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) Wes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Pif No <br /> / APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -► -+ <br />