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21/:) 94 • <br /> ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION z;:: ._ z=_> -'.Wl '4,40 ;, .x._.'t t,.-C2.2 rt. CUSTOMER TO PROVIDE <br /> OWNERJ)A E P. (� ,/ <br /> / �cJ ())/e, / . ✓c`vv [ ning Status;CUP; <br /> OWNER DRESS (Number,Street,City,State,Zip) <br /> 46,r- y& /but S3,5—L 7 Deed Restriction;CSM <br /> Z6 Yl9 6-6S-tail Co �-/'U (N Variance(# ) <br /> (HOME PHONE ELL P ONE E-MAIL ADDRESS <br /> 60 ,35-14,07 6)08 3V7-02-t17 JS ri&t2_ �cof. C-' ,4,_. <br /> Site Plan drawn to scale <br /> AGENT INFORMATION _< CONTRACTOR INFORMATION r` ':, and includes dimensions <br /> AGENT NAME CONTRACT.R NA"I <br /> Tl/v, C,k ic,uic IL iiielTe Plan including location <br /> AGENT ADDRESS C NTRA TOR A DRESS of well/septic <br /> S <br /> 6V .c'etnJpiPPv, <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> C_01-19 e (2cve '� — <br /> PHONE PHONE / pproval from <br /> ‘oP --R '/ -P U ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> (nr plans to scale <br /> PROPERTY/LOCATION INFORMATION +:(http:1/accessdane.co.danewi.usn; vation of property PARENT PARCEL NUMBER: CURRENT Z• ING: ACREAGE: P P rty <br /> ❑ PARCEL ER a K/�7// —05-143_ - S g_1 I rontage drawn to scale. <br /> NUMB <br /> TOWCNSHI�P: �7� SECTION: <br /> ADDRESISI 4 C��� �� 5 r �: I1 6 1/41/: 6E permits county town <br /> (� coun ) <br /> 20 (,o -1 i it() 6Y (,-{u✓L (f C32-Z7 <br /> ❑ rmits <br /> CSM: LOT SUBDIVISION' BLOCK/LOT , rivate) <br /> PROPOSED PROJECT INFORMATION. - ta <br /> r PROJECT DESCRIPTION: r 'k ' , <br /> 0Ait c &4& e-dAi � ii 1 ',.:',..,:l <br /> • ❑This project is a new building or structure. s 4 <br /> This project is an addition/alteration to an existing building or structure. L:: �- V :,SANITARY SERVICE: PERMIT NUMBER: Pi'• t Z <br /> ❑SEWER Si SEPTIC .: , VV-r. ,' <br /> • ? �.A s`r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '• <br /> AREA TO NEAREST SQUARE FOOT: �""°� -_ <br /> ,, �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � V t� ,�� 1_4,-. <br /> BASEMENT. - 1ST FLOOR: / - , <br /> 'A q I L.f3 <br /> d d d S f� 0 U S - 1 4, TOTAL SQUARE FOOTAGE: 4, , .d '�. .. -(—,mr _e' <br /> Ar° r _. , <br /> 2ND FLOOR: 3RD FLOOR: <br /> .33 0 0 / I g stt�p <� <br /> ESTIMATED CONSTRUCTION COST: ° <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? LI Yes gi No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes a No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 0Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes '0 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 A No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes XI No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -1 -► -► <br /> 545-112(4/08) <br />