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iros riii Ito Web•tiii <br /> ZONING PERMIT APPLICATION www.countyofdane.com - - <br /> ROPER7'Y-OWNER"_INFORMATION:P ? L`-iM t ' CUSTOMER TO PROVIDE <br /> OWNER NA E <br /> ��sc in I I Zoning Status; CUP; <br /> OWNER D RESS (Number,Street,City,State,Zip) - <br /> ��- �e �/� Deed Restriction; CSM <br /> 7'3 C A `'� �l �'1 t. .3` ar+C/erpe,� !'e'er 3 - Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI(ADDRESS - <br /> L•e)yyy y/// •j • a'+.Nsp,4..w14/7t'tBe•^ • -P A e Plan drawn to scale <br /> AGENT1 NFORMAT1OJ11w w 5 1C_'0NT AC tsINFOR,Ij_ktro iMEI and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,•01 X -.03.) 1.411, ••.a/ ?!.T Ka...a.AA1 em's SC< e Plan including location <br /> AGENTADDRESS CONTRACTOR ADDRESS of well/septic <br /> 77v4, P•syveti 7 T( L <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> ,,t�-,Q�(„�L c c ecr <br /> '` �/ or,, � s'3s <br /> PHONE HONE ` i - 815 Plan approval from <br /> (6 on d-„ -o _ 63,7 <br /> - applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - <br /> T=3ipbet C , 41f ti f, \ `• _ 4.F.{eor plans to scale <br /> MREItTYILOCATIONLLII FORAAt1014 >(14W/a Cefie aneeb*ne wusl) <br /> PARENT PARCEL NUMBER: CURRENT ZONIN : . ACREAGE: ' Elevation of property <br /> eiSARCEL o?�_O6 ^/! frontage drawn to scale. <br /> T <br /> UMBER fe lw.1o1 SECTION: <br /> ^ 7/6/ 8E <br /> Al peilp o•^ '/4:/VE 1/4'/4: s? ❑Driveway permits <br /> ADDRESS (state, county,town) <br /> Gi�` le, Ph y. l cC y rt ; ,. <br /> l ary permits <br /> CSM: LOT SUBDIVISION B OCK/LOT • <br /> la R,..6( Y7tfi s (public, private) . <br /> PROPOSED-PROJECT INFORMATION fy = w 7�-4�- ST ii REi7� �� <br /> PROJECT DESCRIPTION: r_, 7- 1 <br /> 4/e 4 5. f'P �•.....•-1 ( ?' ''he Arai . <br /> . ,'his project is a new building.or-structure. - <br /> ❑This project is an addition/alteration to an existing building or structure. �_ __--4} <br /> SANITARY SERVICE PERMIT NUMBER: .fAaa'es , i 'n <br /> EWER . ,EPT1C lZ,!"d'vl4". ooiCJ : ge V8 IS '19,E zi- <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -� - 1 .. ��- <br /> 02.1. D ' .,� c e)=ti IoQSie X41= S. <br /> o -- ._.. <br /> tlo.3a.r ,---_ tap. it,ep . <br /> AREA TO NEAREST SQUARE FOOT: 1 3 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) r <br /> BASEMENT: 1ST FLOOR: • i ?a s r� pe t7 <br /> C) , • 4. TOTAL SQUARE FOOTAGE: 4, ,:.. .---_ � Sf, 6 9I:" -. <br /> 2ND FLOOR: '�•l 3RD FLOOR: **-1_-= ', <br /> ESTIMATED CONSTRUCTION COST: $(Please round to nearest dollar) ♦ ♦ ♦ ♦ •P 9C"Ufdwe�'` �__ -_0c -- <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes-' jalillo.• [.Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes alTo .QDon't know . <br /> 3. Have you talked with the township about your project and are they in agreement? des S7.•. <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? QYes : 'RIMS : . <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) ,HY es �[JNo • QDon't know <br /> 7. Is this to correct a violation? - [Yes Rio • <br /> -4; <br /> V <br /> /. 5 .APPLICATION MUST BE SIGNED <br /> I <br /> (Continue on Back). -► -► -> <br /> 54S-142(4/08) - <br /> • <br />