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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT_to:Web App#' <br /> w <br /> 'PROPERTY`OWNER INFORMATION: < ?: <br /> C <br /> S OMER TO PROVIDE <br /> VI <br /> D <br /> E <br /> O�-� <br /> /o ' ''" / I' 5 0 Zqfning Status;CUP; <br /> OWNER (juinyer,Stree /fate,zed, Deed Restriction; CSM 6r t%, Variance(# ) <br /> H E 8 HONE CELL PH r WAIL D S /9O �Q%a ` i L ` V(CC41QAiO6 .O. Eli itePlan drawn to scale <br /> AGENT INFORMATION• -:. CONTRACTOR_INFORMAT,ION ° ;}t . `, nd includes dimensions <br /> ' AGENT N....:0; - .; OR • 1 <br /> r <br /> /fie ---9 Thb ,v G ,,t,00- EiSite Plan including location <br /> AGENT ADDRESS CONTRACTOR DI RESS of well/septic <br /> CIO eeA,waw s/ <br /> (City,State,Zip) (C te,Zi ) / �1 backs <br /> '-, /,J [ I <br /> PHONE PH NE / ❑-Site Plan..approval from <br /> Cb- -5 oy-D 3Z, a0plicpb1e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> 4 f<• r �� , rc°,(G_, �l, / ' loor plans to scale <br /> L.:PROPERTY/LOCATION`INFORMATION (http://accessdane coda_ ne wi.us�-� NM ' <br /> PARENT P•'CEL N. BER: CU" TZONING: ACREAGE. Olevation of property <br /> f onta a drawn to scale. <br /> El PARCEL .���frr� ,�i .� 5 Q g <br /> NUMBER ,•��J►, a1. 7 -, <br /> TOWNSHIP: r I - .79 S C N: _ 1 <br /> ::2( Q 7.- it' U 1,5 /4: J� 'V V ' , ,c aDrivewayupermits <br /> -7040i, b t/ ' �4�'' Kstate/'county,town) <br /> ADDRESS: 9 . G ' ` w`'� ' V\ ©aC <br /> 7JV� 1 <br /> CSM: LOT SUB VISION BLOCK/LOT San ary_•private) <br /> is <br /> (∎/%Q 7 ,� (pubs ,private) <br /> PROPOSED PROJECT INFORMATION TAFF RVIEW <br /> E <br /> PROJECT DESCRIPTION: - t <br /> c//;‘, (e_ / u;t l g <br /> trin Distract l t <br /> = ?7 z-z i r <br /> . RThis project is a new b ding or structure. �J Permltfed Use? <br /> ['This project is an addition/alteration to an existing building or structure. . � t ,1 "F <br /> SANITARY SERVICE: PERMIT NUMBER: ® . al Address 1t <br /> t �J <br /> EWER ( EPTIC /3..- 1.0/6'- 003 1/ �(ne existing) 1"_ <br /> x ' � <br /> HEIGHT IN FEET - NUMBER OF STORIES: (Not including basement) w <br /> /Y 7,1t _� etland/Floc plash/ <br /> r AREA TO NEAREST SQUARE FOOT Shorela (attachment) = <br /> (Outside dimensions including unfinished area,attached garages and all v r e decks or porches) ` ' r, s� F I <br /> :E ErosionControl petmit A^�-, -kO <br /> BASEM �/ 1STFLO0 �- J - - ,. ri' \ t <br /> L '-} /�i�f� TOTALsSQUARE FOOTAGE: •j, ' 0slopes,disturbance _ v <br /> 2ND FLOOR: 3RD R rT � r Illflg/aCGeSS . <br /> ea :' `� : '% ¢..s�F' _� : ,. vac <br /> (!.../..i;' ? <br /> yli Revle�nr�Lo_atlor0 4Urvey <br /> ESTIMATED CONSTRUCTION COST: ' � �� <br /> ^� ,��**� -and available options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ tX ��/ V _ ', ,T4fiti� r ' .`� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves Dallo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des EiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? W 'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves . 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) Elves , No ['Don't know <br /> 7. Is this to correct a violation? Elves 1lo <br /> APPLICATION MUST BE SIGNED <br /> Q)545-112 /� (Continue on Back) -► ♦ -►(aoet 1'`�1 JI <br /> • <br />