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J <br /> ZONING PERMIT APPLICATION www.countyofdane.com Fr=i:=ECC=111 <br /> PROPERTY OWNER INFORMATION '' FFIC USE ONLY <br /> OWNER NAME <br /> .Fc.Ne I I;Li m L/ kl PI Zo ng District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /� <br /> - 4/1417 B( 4k69 '�tef9 ,g CEtrace 6eDoe f W/ 5'3527 ❑ ermitted Use? <br /> PHONE �� 9 i E-MAIL ADDRESS <br /> _ ❑ Zoning Sta ;CUP; <br /> AGENT'INFORMATION" ''' CONTRACTOR INFORMATION'' ` 1' D d striction; CSM <br /> AGENT NAME CONTRACTOR NAME ar' nce(# <br /> ccan.)e ril-eaweI( -1%f3�2u�el, root.: ( ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS ��11 <br /> SSE ic ,rN 3/948 C6uiv 4{ eo, 11L7 Sit Plan drawn to scale <br /> a includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> i41 t4OL. b UI £.‘p( s'"3-718 ite Ian including location <br /> PHONE — PHONE <br /> (908 -22-2.--/ 786 of ell/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -cpewel/? �A�4'�5, A-AR — etbacks <br /> PROPERTY/LOCATION INFORMATION ' (http://accessdane eo.=an <br /> ®vtn•us� ' 0 Site Plan proval from <br /> PARENT PARCEL NUMBER ZONING:/ ACREAGE: <br /> ❑ PARCEL 0 i 47// l61 HO o A 84 ) bill appli le township. <br /> _NUMBER <br /> TOWNSHIP: SECTION: , ^ ❑ Rural ' •• = s <br /> `.,�j 111e, C&Due 07 )0 1/: Ne 1/1/4: vS <br /> ADDRESS {,� (new :xistin• <br /> 914 1 i &cK&Qy RId .1 R' ❑ Floor ans to scale <br /> CSM LOT 3 SUBDIVISION • BLOCK/LOT <br /> E. Ll o operty <br /> PROPOSED PROJECT INFORMATION fronta yawn to e. <br /> PROJECT DESCRIPTION: p C ( <br /> /v/,3C ' 12W'�` twM MI' ' "C'Z' ❑ Drivewa ermits <br /> . L1 This�.roject is a new building or structure. (stat ,county,town) <br /> iris project is an additio Iteration to an existing building or structure. <br /> ❑ Sanitary mltS <br /> SANITARY SERVICE PERMIT NUMBER: <br /> :J SEWER SEPTIC (publ' , private) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ❑ Wetlan oodplain/ <br /> Sho and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionContr permit <br /> BASEMENT _— 1ST FLOOR: fpes 1 TOTAL SQUARE FOOTAGE: j turbance, <br /> 2ND FLOOR Cess) <br /> 3RD FLOOR iew Location Survey <br /> (Please r ED CONSTRUCTION COST' ♦ ♦ ♦ ♦ ♦ �2 �,� and available options. <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 IINo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes f2No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes ktil No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes ❑No ? <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes 1l(No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes ('No <br /> - 4( 7S ________ APPLICATION MUST BE SIGNED <br /> 4 (Continue on Back) —► —► —► • <br /> r.ts-nz(1/06l I <br />