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• 11.0j LEMENT, tolWebg itril <br /> ZONING PERMIT APPLICATION www.countyofdane.corn - <br /> • <br /> ROPERTYrOWN R � -,, <br /> Ey -INFORMATION: ? � -- Asl A— CUSTOMER TO O PROVIDE • <br /> OWNER AME _ . 141/r <br /> -/- 4 �-� <br /> i�S Mow. �.n�"x-., �-- � - ing Status <br /> OWNER ADDRESS (Number, treet,City,State,Zip)`�' Deed Restriction; CSM <br /> S' ----) / , 1 ,�{. �� Variance(#1. 3„1(:) ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • I Site Plan drawn to scale <br /> l4GENTIINFORMATIOt1 T r �5w ,CONTRACTO6-1NFOR T ON"6 zy=�->- and includes dimensions <br /> AGE T NAME CONTRACTOR NAME <br /> Q� n Site Plan including location <br /> AGENTAD[]82SS� CONTRACTOR ADDRESS of well/septic <br /> 5 f -7 1a115) <br /> x . <br /> (City,State,Zip (City,State,Zip) n Setbacks <br /> PHONE PHONE n Site Plan approval from <br /> vi 1(4 ES'3 q ? 1-`7 q 0 - applicable township. <br /> E-MAILADD S _ E-MAILADDRESS - <br /> n Floor plans to scale <br /> PROP0.RTY/LOCjAtON Ii.#11 041:0MtAiiip;/laecessfane.00sdane u et-i- .=_ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: n Elevation Of property <br /> ElPARCEL p� �i �f a frontage drawn to scale. <br /> NUMBER 0 S I� �I % ciD. \ �e- / 1 oq) -3 1 . 7 <br /> TOWNSHI : SECTION: <br /> A I b\r „`, :s.--S '/: '/4'/4: ❑ Driveway permits <br /> ADDRESSS /1!, l (state, county, town) <br /> r' ` I�(�p • n Sanitary permits <br /> CSM: L■T SUBDIVISION BLOCK/LOT <br /> (^^` = / (public, private) <br /> Y v <br /> PROPOSED-PROJECT INFORMATION__ ,..� - SYiP'IRE�`II1E1 ` -*� <br /> A-d% filC'l 1'PROJECT DESCRIPTION. 5J 1 -___ ) __ _ ff,i,- -f.`�° -'' <br /> 11ra], a DT (C : <br /> • [This project is a new building orstructure. 4 <br /> [1This project is an addition/alteration to an existing building or structure. -s= af, .f.---I__ <br /> SANITARY SERVICE: PERMIT NUMBER:” ` Aa.Te5 `-- <br /> EWER - -�,�EPTTC 1N/ _ . _1 8W-e s-� <br /> 'iii . m, -. ,�_ <br /> HEIGHT IN FEET I�1 NUMBER OF S OR ES: Not including basement) '_= - = <br /> . j _ <br /> 3s :. 1aird--1 ens_ <br /> AREA TO NEAREST SQUARE FOOT: a"...--_ _ <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) = -4.= _; - <br /> BASEMENT[ , 1ST FLOOR: O l a - r a eel t <br /> G` ' ,, TOTAL SQUARE FOOTAGE: •� e_5 e_15 U 5a9�' ' <br /> 2ND FLOOR: 3RD FLOOR: p,1 <br /> f� <br /> ESTIMATED CONSTRUCTION COST © A .4 e c 1 <br /> (Please round to nearest dollar) '♦ :-0. ♦ -► --0. --> S/� 3-74-__E---:-:_.--. .,----:- 4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake'? Q <br /> Yes ' No.- fDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? Yes QNo .QDon't know . <br /> 3. Have you talked with the township about your project and are they in agreement'? [Wes QNo. - . . _ <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? [Yes : ONO • : <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 QNo • QDon't know <br /> 7. Is this to correct a violation? - [Yes QNo _ <br /> • APPLICATION MUST BE SIGNED <br /> - • • (Continue on Back).'--■ —► -+ • <br /> 545-112 Nos) - <br />