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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com 'SUPPLEMENT to;Web App;# <br /> pROPERTY OWNER`INFORMATIONk'• L ' N._ CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> '16"1---\ -0 D Ae--s`C-L`ri. & t.� t 'F Zo g Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> .S S � eed Restriction;CSM <br /> Li S a ■ N ‘.-1 P'. LIP,�t ,.,�■ 0 P L� a.0 w ' (oZ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS • <br /> • n S.te"Plan drawn to scale <br /> AGENT::INFORMATION ::`CONTRACTORC INFORMATION ',;,,. and includes dimensions <br /> ' AGENT NAME CONTRACTOR NAME <br /> glrPt-Nr t'T CLy tr,.N_S Sit tin including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> S'l11 V+,loa,A 6-0 <br /> • <br /> City Stale,Zip) (City,State,Zip) asks <br /> \(/(City, <br /> r-' -o t S pr- u-11 S-31 11 <br /> PHONE PHONE O Site PI a royal from <br /> C, o'3 S2_O &I o g - applica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> —0 U..3`L,E-® p M te_1 C et e- oor plans to scale <br /> 'PROPERTY/LOCATION INFOR MATION _(htt llaccessdarie coda ne wi us `2 <br /> P' �� '�"` "` <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: vation of property <br /> ❑PARCEL (� rontage drawn to scale. <br /> NUMBER 07 CTb C I �/a p 0 ' ' ' 1{�' <br /> TOWNSHIP: SECTION: <br /> 44 $ '/4: NJ E, WA: 1`1 1,/ Drive rmits <br /> ADDRESS: J (state ty,town) <br /> 14 S n ( fV ,u(\ Sani ermits <br /> CSM: LOT � <br /> SUBDIVISION BLOCK/LOT ( IC, vate) <br /> 1 / 'M»t • -SS <br /> PROPOSED PROJECT INFORMATION $ <br /> • AFF REVIEW .:. <br /> PROJECT DESCRIPTION: 001 SL P te-/ !f� l( Wing; <br /> Ds t nct r� k,Y . _ <br /> This project is a new building or st ucture. �11 ` `` <br /> ❑ P J 9 e1-mltfed l r.p <br /> This project is an addition/alteration to an existing building or structure. , �, a <br /> SANITARY SERVICE: PERMIT NUMBER: R Kai Address <br /> }�,� ,V new/4 Wig" <br /> EWER VC�EPTIC <br /> HEIGHT IN FEET /////"`�`����' NUMBER OF STORKS: (Not including basement) <br /> I El 1Ne dplam/ <br /> hor t. Atachment) 'i <br /> AREA TO NEAREST SQUARE FOOT: ' 4 r, <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> ,:1Gi Ere •i o ontrol permit' <br /> BASEMENT 1ST FLOOR: - r <br /> 4, TOTAL SQUARE FOOTAGE: j (slop • u,bance <br /> Z: fills acres ) if <br /> 2ND FLOOR: 3RD FLOOR: ll(� -r ,,,, ,„s <br /> -f� Revle LOT Ion Sbniey <br /> ESTIMATED CONSTRUCTION COST: and va a ' e opt ons$ <br /> (Please round to nearest dollar) ♦ ♦ --► -+ ♦ -i 's <br /> ; 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ONo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Oyes nNo <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) OYes alo ['Don't know <br /> 7. Is this to correct a violation? [Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(4/08) . <br /> • <br />