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lfi7 Cfi- <br /> ZONING PERMIT APPLICATION www.countyofdane.com F3:12:1=7 <br /> 6 PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> hL L� ((tat�e., t *tai e LL 1 0 Zoning Status' P; <br /> OWNER 1�C Q 1 RESS <br /> e.(Number,Street,City, �e,T M .I L5 h( lt u- _. _ r 5-%1 Deed Re t• ion;CSM ) <br /> Vari HOME PHONE ':CEL PHONE E-MAIL ADDRESS <br /> e.0US—SS 51---31-CL Coc)S-225- 527 LE re tip'.. 1 100 rr1 Li l (O')--1. ['Site Plan dr n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl s dimensions <br /> AGENT NAME CONTRACTOR NAME _ <br /> Leo rt.(nc E e I~C ee-s ❑Site PI cluding location <br /> AGENT ADDRESS CONTRACTOR AD ESS M C� of well ptic <br /> _ ,.>a ire ct..s h c .sl� <br /> (City.State,Zip) (City,State,Zip) ❑SetbV <br /> PHONE PHONE ❑Site Plan p from <br /> appiicabl hi . <br /> -S()Len e,., <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> :Same-, ❑Floor plans scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane,ca.dane.wi.ust) Elevation of pro e <br /> PARENT �PAyRRCELNUMBER: y n CURRENT ZONING: ACREAGE: frontage ev drawn t scale. <br /> NUMBER o Jd I `I34-9,.�Ltr'.._lj �' RH �7. 1 <br /> TOWNSHIP: SECTIO : r / <br /> C ,__ . . , �Drivew , .el:�� <br /> TLw.c��..� trt=_ ,SLt.r) i ratrC-C !. /4: \s WA: ,5E (state. • <br /> _ __ own) <br /> ADDRESS: <br /> ❑Sani • • yp :_ <br /> cSM: LOT 1 SUBDIVISION BLOCK/LOT (pub+ p -te) <br /> PROOPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> nee I n stc L(a;h f (-L-A-Der3c10,, LI Zonil�g district <br /> This project is a new building or structure. ❑ Per tt se? <br /> QThis project is an addition/alteration to an existing building or structure. �/ <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralAddress <br /> EWER ,EPTIC e' (new/e �� <br /> HEIGHT IN FEET: i `Q NUMBER OF STORIES: (Not including basement) <br /> �,(C�Y Ce_. -S C , p t CL!1 I/S `rCS 2 ❑ Wetland/ dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosiDtl+a of permit <br /> BASEMENT: 1ST FLOOR: <br /> 1 <br /> I 0 {.TOTAL SQUARE FOOTAGE: 4, (slopes isturbance, <br /> (/V — filling/access) <br /> 2ND FLOOR: 3RD FLOOR: h t(ASt'./} <br /> l£ 1 1 Q-5 , ❑ Review Loca on Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ and avail I options. <br /> (Please round to nearest dollar) I Qto <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes jaio ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes k� o ['Don't know , <br /> 3. Have you talked with the township about your project and are they in agreement? es •' o etf1r1t+[�nd ii <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? tYes �o�Z.c)l'lt r7�-3 C&PPr 0 f <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) QYes lei o QDon't know <br /> 7. Is this to correct a violation? ❑Yes i:/ o <br /> zb Cei C`J e 1(22_j'� APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -?• -♦ <br /> 545-112(4!081 AA( #10 VOICI i <br /> - c hr,,. �--�t � 'f3 °O 4 7 S�z-a <br />