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------- :::) e r Irv\ )47.s ---- _5-1--f,--d-,,. its <br /> ZONING PER IT APPLICATION www.countyofdane.com ,:Stipm.F.MENt lii.web 4ipii <br /> PROPERTY OWNER INFORMATION: , r,: • . •4. CUSTOM TO PROVIDE <br /> OWNER NAME <br /> e V S U t "]� <br /> oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> „ -e m c ( hr i I m 4 �•G �I g7 5-4• Deed Restriction; 1 <br /> .� � d I J �Variance(# 'it p/1 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS • <br /> n S ieerran drawn to scale <br /> AGENT INFORMATION .:CONTRACTOR INFORMATION.s' .a ,`, /and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS O ell/se ' <br /> (City,State,Zip) (City,State,Zip) S acks <br /> PHONE PHONE ❑Site oval from <br /> appl' le wnship. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> Fl r plans to scale <br /> :PROPERTY/LO CATION'INFORMATION (ilittpe/laccessdane coda ne w.us!)CM- „ <br /> PARENT PARCEL NUM ER: CURRENT ZONING//A la ACREAGE: anon of property <br /> ❑PARCEL 0/� / 245-q5/0-5.- frontage drawn to scale. <br /> NUMBER V ( ! C ” 2 1 <br /> TOWNSHIP: SECTION:2 Lj' , i_ , El way per. its <br /> d3 /(/d PI ( n5 G rev( (Y: S 'E //4. $ (state, . <br /> ADDRESS: -� ty,town) <br /> 33145- F-e rn r 1 Fr /9( 4 $ PO 11:1 4-37/7 ❑Sa •.•, .-,. its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (publi , • ivate) <br /> PROPOSED PROJECT INFORMATION = ST F REVIEW <br /> PROJECT DESCRIPTION: $b s } <br /> 1 .r{ k o v S C S XM ring Dlstnct rl <br /> ❑This project is a new building or structure. �P mltfectUse? 1 <br /> y rr* <br /> [ his project is an addition/alteration to an existing building or structure. ' s a <br /> SANITARY SERVICE: PERMfTNUMBER rah •• SStk <br /> [ EWER �EPTIC (new/ XiSting s <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ' <br /> ® etlan'�,o95F lair/ <br /> F •reland{attachment} <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) f r r t `r� <br /> roslonCo of perrmit .ems <br /> BASEMENT: 1ST FLOOR �slopesdlsturbance tby 11 / 4, TOTAL SQUARE FOOTAGE 4, , -�,�--7 <br /> l-� �j filflriac es / <br /> 2ND FLOOR 3RD FLOOR y //0 O s-�-e�„`"? z.�,ems', �� <br /> ,s Y �+f4 f'�2 . o'Fot's+t ac,.,..r 1 <br /> x Y,IP- L}ocatlor,SUrvey <br /> z�. tiK �.���r-9-� <br /> ESTIMATED CONSTRUCTION COST: ' f and available o lops <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �'� , , l,, 5;.t z _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [alo ❑Don't kndv✓ <br /> 2. Is there a wetland or floodplain on or near the property? Etici Olo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eqs ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Dyes [` <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► - -► <br /> 545-112(4108) <br />