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1 14 - ?‹ -D—1 S ---- / 07 L 1 4-S( 'r:: 1 S 74 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �� <br /> Mtcld/Q DoacoCR-I0 l Lei t "Si Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 'Deed Restriction; CSM <br /> 1 7O1 ;�d.v.(/ T,P#'i_ OA,/ T' 5 3 S7S- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 71- /21d g M r o •il d�r 4• e,_ rkw' 1 • G°isi b ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ' <br /> S'.e ub r,q 1'�cc,lcleC S LLe . � inincluding location <br /> AGENT ADDRESS CONTKACTOR ADDRESS ^ Of W h \IC 0 nj <br /> w on �/,OiM-e i2 � <br /> City,State,Zip) (City,State,Zip) ,14 Setbacks <br /> PHONE PHONE Site P proval from <br /> (QOS- ICS--X00 appli township. <br /> E-MAILADDRESS E-MAILADDRE S �t <br /> o to/A. <br /> e ' m..-- (°Ai -`-'� Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus!) <br /> PARENT PARC L NUMBE R: CURREN ZONING: p_i ACREAGE: levation of property <br /> y <br /> Li PARCEL 28�o(9!d-34?-y,2O2 -1 �� �7,-I frontage drawn to scale. <br /> le. <br /> NUMBER <br /> TOWNSHIP: SECTION: // <br /> DIA 1414 .3 '%: /vim 1414: se., Drive ermits <br /> ADDRESS: <br /> (state, ty,town) <br /> n 0 7 oi,/, r I iLe.g/ Ore 6‘, 491' 5-3-S'7.S.-- Sani rm s <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (publi vase) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3 .-C4a uAra/f ,/C-AcC(V ie-ete &V sroK4-7e s cr 4°1'4 oningDistrict <br /> ui This project is a new building or structure. Permitted Use '?' R L_ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT BER: R ral Address <br /> ❑SEWER rykSEPTIC , (rte <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 it-1 _ / " a Y1letland/FloodpiainI <br /> horeland <br /> AREA TO NEAREST SQUARE FOOT: (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> r0 s i pernia <br /> BASEMENT: 1ST FLOOR: 4 TOTAL SQUARE FOOTAGE: 4 (Slopes, +- r 0 a ..-,r <br /> 2ND FLOOR: 3RD FLOOR: NH ) <br /> S-2 CJ A/32 /' Review Locatio , <br /> ESTIMATED CONSTRUCTION COST: – . –0. -0. --lo. ,�0 - d available'option- <br /> (Please round to nearest dollar) <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? ❑Yes 0,No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ..-- Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />