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• <br /> i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME c, i 9/ l <br /> QGV0/1*J vu-e tLk4&r -Zing Status;CUP; <br /> OWNER ADDRESS (N r, eett,City,State Zip Deed Restriction;CSM <br /> I-OME��NE ��ELi PHONE Star r-MAIL �� Variance(# ) <br /> ,I, 5 - - /119 0, - ;d la/ I i f( 4'11/ (OM Site P drawn to scale <br /> AGENT INFORMATIONI I CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME <br /> 1 �+N,1oci. (L lV �s looks g JI 1 L� IN Site an including location <br /> AGENT ADDRESS CONTRACTOR RESS • ell/septic <br /> 1.7b2 QVeA rrc) 1 `77Z aMver yTici j i <br /> (City, to .ip) �+ ,T (City,State,''p) etb kS <br /> 1 �, in n WI 5356.2-- P 1" -1 h WE S 351 Sit P approval from <br /> kiJR ONE pp <br /> /� (�1 / — Q ap 'cable townshi . <br /> AILADDL �3 !l EMAIL IA\ (Q� ! l p <br /> I ! _ter a I/L0 ALI 0 , AO n JAW 4 (la <br /> plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �levatl of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ' " ACREAGE: P P rty <br /> ❑PARCEL 6 - 7 (� f ge drawn to scale. <br /> NUMBER , t� / / �� _�J� �� Tel�.. <br /> "Wil SHIP: SEC <br /> O Ii ii '/4: ,1n/ '/.'/4: klik, <br /> � ew arm <br /> ( ,county, <br /> own)r ADD SS:1 0 ( a rV i � Sani - ti,:' its <br /> . LOT SUBDIVISION BLOCK/ 0T <br /> 915 3 <br /> • • i.,private— <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIP ION: <br /> S/n Y .j 1oiY oning District <br /> . his projtct is a new building or structure. fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> ❑ P 1 9 9 <br /> SANITARY SERVICE: PERMIT NUMBER: il '.- [Address <br /> EWER "EPTIC 13-Z0110-0 oz z j, xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 32 ❑ Wetlan. ••dplain/ <br /> Shor- - d -ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ E sionCOntr ermj <br /> BASEMENT: 1ST FLOOR: <br /> 1718, Z QQ�{J0 j TOTAL SQUARE FOOTAGE: ,j (S • ante, / <br /> 3RD (-- <br /> Th <br /> 2ND FLOn°' fillip /access) <br /> FLOOR: l 1 <br /> ' i trgq 4 t//? - - eview Location Survey / v <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ ob and available options. <br /> (Please round to nearest dollar) $ 1 53, 3/7. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ,lo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ', io ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? iZes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ) )•o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if non-) <br /> 6. Is a location survey required? (see reverse) QYes )3Vo 1,74''Don't know <br /> 7. Is this to correct a violation? :Yes ` to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />