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-140 <br /> ZONING PERMIT APPLICATION www.countyofdane.com =SUPPLEMENT#o tiiweb App:#. <br /> 'PROPERTy.bINNERINFORMATION_ : z . „A` _,,; .4 . CUSTOMER TO PROVIDE <br /> OWNER NAME � - 3 <br /> Pie)L A I ' O�S 1-o�•- I Zoning Stat ; CUP; <br /> W <br /> ONER ADDRESS (Number,Street,City,State,Zip J <br /> /� Deed R ction; CSM <br /> I 1c San t\SC (I /?4-�"(e,n(ll Variance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> G oe • iS 5=c77� • ❑Site Plan dr-wn t scale <br /> AGENT INFORMATION `CONTRACTOR INFORMATION` ;ggg, and inclu:-; ons• <br /> AGENT NAME CONTRACTOR NAME ��..// <br /> , <br /> ex . (,.,5fi�r,., (0n5t ❑Site P a_•.i gloct n k,u AGE NT ADDRESS CONTRACTOR ADDRESS of wel .;%! ro„,p� <br /> (City,State,Zip) (City,State, ip) ❑Setba I <br /> >ee.iik� J t�L ---3 C"--7/ <br /> PHONE PHONE _ ❑Site Plan a••r.•.i f em <br /> 620'c 3 5 Y_iJ S 3c applicable i .. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> C` f G S � rrl a IVC O n Floor pla <br /> 5-}es6de <br /> ;P.ROPERTY/LOCATION INFORMATION '(http//accessdane co_dane wk riag ❑Elevatio a prep= <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: . <br /> ❑NUMBER C5-Q/0 S-I J -°4 3-q -0 frontage d .% , -vale. <br /> TOWNSHIP: SECTION: <br /> SeGk'i,n 9 j-N\'1cn, 5�...�-s-tohi-%s:5 W %4%4:11&-)'I^L ❑Driv jFy, its <br /> ADDRESS: (stat ,c ty,town) <br /> _ ❑Sanimit \ <br /> CSM: LOT SUBDIVISION BLOCK/LOT iii , <br /> (pu ate..,,,,.. : , .PROPOSED PROJECT INFORMATION ,. = - STAFF=R VIEW <br /> PROJECT DESCRIPTION: I t' / • <br /> X Lite CO r l Zonin ' t-rj r <br /> a� U,�Q !\ �� lun PeW, w� 9 <br /> • ❑This project is a new building or structure. ' r .z t f` `` <br /> -� Permltfed Use? 4 ,. <br /> This project is an addition/alteration to an existing building or structure. = � ". _° <br /> SANITARY SERVICE: PERMIT NUMBER: MI :RUral Address x ~ <br /> EWER [EPTIC/ , �(new/e`xisting) <br /> HEIGHT IN FEET <br /> r NUMBER OF STORIES: (Not including basement) <br /> Am '/7\ (0 Sh Orel and;.(attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '-',=--. - = c <br /> BASEMENT: 1ST FLOOR: r!� r0$IOnControlp'umit <br /> �t/� / 4, TOTAL SQUARE FOOTAGE 4, ' "-.slopes dls_tu�bance <br /> 2ND FLOOR: 3RD FLOOR: / v ` 15- filling7acces.t} <br /> CA- Revle }o� tlon Survey• <br /> ESTIMATED CONSTRUCTION COST: - �"�r3`� <br /> ♦ ♦ ♦ --► ♦ ♦ and a b options <br /> (Please round to nearest dollar) V r UU _ - : ti _ �; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? UYes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes ❑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 ❑No <br /> APPLICATION MUST BE SIGNE►D <br /> 545-112(408) . <br /> • <br /> (Continue on Back) —► ♦ — <br />