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<br /> ZONING PERMIT APPLICATION www.countyofdane.com NT to;w,eb App;#?'.
<br /> :PROPERTY;OWNER INFORMATION;- . _, ` CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> DAM hri0 (, /;S'DNi, rQ I )< D Zoning Status; CUP;
<br /> OWNER ADDRESS�(/Number,Street,City,State,Zinp) Deed Restriction;CSM
<br /> Li ti/ �) ail c Y /.�,1�' (�'t/` I 1 Iii 7 53'71/ Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ' - 51 y-/ci l Z ,,O3-57 V-/Idl 12 'n-fb e.MU-9( e, riq,i,exwt ❑Site Plan drawn to scale
<br /> AGENT INFORMATION, . : DONTRACTOWINFOROAteiCM-Nt.f ._. and includes dimensions
<br /> ' AGENT NAME CONTRACTOR NAME
<br /> / Y O! Ci/=4Vu.cnON Ll L: b AI CQA611 U►I S LLB II]Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS ' of well/septic
<br /> 69011 G>414A-sr l`t if0 ,14S c q v9 Ci, its r Pi 0 . i z s l
<br /> (City,State,Zip) SS (City,State,Zip) ,,-` D Setbacks
<br /> (9IQD IU'"j WI .- 3 SQL /11/04 . / L- L 5-33 t
<br /> PHONE PHONE D Site Plan approval from
<br /> 3Yc-/o 5$' (JS-3 5-/(5g applicable township.
<br /> E-MAILADDRES / 1!� � f/ E-MAIL .
<br /> CA ( BA5(x(Gvl />�C(710n ,Cawt c4;' c�j fc►,Cat ria-km' ,c' ❑Floor plans to scale
<br /> :PROPERTY/LOCATION'INFORMATION (http://accessdane co da_ ne wi us/_t_ :::} Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENTZO NG' ACREAGE;„
<br /> El PARCEL NUMBER �'7ycP JZ,� E' � ` �l 6 �-' frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> 6.(go 6/�6(6%--t._ 3 %4. /%: D Driveway permits
<br /> �f (state,county,town)
<br /> ADDRESS:
<br /> / V/3 L746 Y /Z045 //4/4-b,52,4') i 1---) 1 S3`)/ ( 0 Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION =`l STAFF REVIEW
<br /> PROJECT DESCRIPTION: / J, t1ti'
<br /> 6 u I t.r /2 0x �!? b o ind,S �-5',)(,ik S)1 7 0 Zontng District z 4
<br /> Iii Ol /
<br /> ❑This project is a new building or structure. r ' ` ��
<br /> Permltfed Use- ; r
<br /> This project is an addition/alteration to an existing building or structure. '-'• :: ,,
<br /> --r z y c t-r ,5
<br /> SANITARY SERVICE: PERMIT NUMBER: ..® Rural Address j .
<br /> EWER EPTIC � (new/exlsting� .-,-,2,. :;,-2 '
<br /> x '
<br /> HEIGHT IN FEET / / NUMBER OF STORIES: (Not including basement) =
<br /> -❑ Wetiand/Floodplal"/
<br /> Shoreland(attachment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ,- - . -. : F
<br /> �® ErosionControl permit'
<br /> BASEMENT /6 1ST FLOOR s -'
<br /> S r 7/6 5 4, TOTAL SQUARE FOOTAGE j 3 �siopes ,e.,0. rbance
<br /> f f Ilingt ccess 4
<br /> 2ND FLOOR �_ 3RD FLOOR / 't-`V n ¢4C_e v
<br /> „fl lReview�Locat�Survey
<br /> ESTIMATED CONSTRUCTION COST: `{ f� '` � � 3` x3
<br /> Please round to nearest dollar '- '4 4 . ♦ '� and available options
<br /> ( 35- Q oo; t.;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes XiNo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? es o DDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? es N o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - L]Yes dNo
<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) Ores E o DDon't know
<br /> 7. Is this to correct a violation? ❑Yes 0 o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -►
<br /> 545-112(4/08)
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