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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION OFFICE USE ,`ONLY <br /> OWNER NAME t <br /> R V 17 � motel Se4"se ❑ Zoning District <br /> OWNS ADDRE S (Nimb Street,City,State,Zip) . <br /> 6 3 0 S /e,..."- L =. / <br /> PHONE � y S� U P ed Uses, <br /> E-MAIL ADDRESS <br /> 60J- 813 2 - ;5rr <br /> `❑.Zoning status-,Rwo <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed lestnct[otr,CSM: <br /> AGENT NAME CONTRACTOR NAME <br /> n e/Ala-r/ t( S'Arh`4. RAvs 1469w-5 <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> VV 1 aIte AtarY drawn;to scam <br /> '7/!((xr ,v0,, 7// GY' £ and Includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> 5 t P � to Seair ✓ .� 5? a 5.4.4, Azzi � t.,2 . 310 Ie a nud c <br /> PHONE PHONE IllibfeotittpptrpaitasiligreagERY <br /> C,of- s7._s-�ctr/ 6° x " 832 -032y <br /> E-MAIL ADDRESS E-MAILADDRESS ❑I tba lcs <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dtane.wi.us/) 0 Sitert Pl4n approval f om <br /> PARENT PARCEL NUMBER: O� l� ZONING: ACREAGE: , a .1tcable=tc�rVnshlp sx <br /> NUMBER ��- oal S : <br /> TOWNSHIP: SECTION: <br /> /0 CoAr d'f s;•v■ a;17Y /Yc /4: Aft': /</4: 8Ki�< <br /> �'ne�T�xlstfng) <br /> ADDRESS: <br /> 6 3oS %v<y - i -sue /'' -' <br /> ISI 0y Floor plans to scams <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> SS t Elovatlorl:of prop rty t <br /> PROPOSED PROJECT INFORMATION .. 0 rortta e'drawn tb-scale <br /> PROJECT DESCRIPTION: L <br /> Ater. 5 i'c f Zy 2 570 /7044S r st ibliiiiiiiroOmmeN <br /> . &Tt11S project is a new building or structure. 4.144400150#10.211.r <br /> ❑This project is an addition/alteration to an existing building or structure. �, <br /> SANITARY SERVICE: PERMIT NUMBER: Saflltaperrrtlt <br /> �/�.� (public', nvate, <br /> ❑SEWER SEPTIC r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ 1lt(etland/Floodplaln! <br /> 2 5' 2. Shore*d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Erosto[I� OTttrol"per�mi <br /> BASEMENT: '1ST FLOOR: f <br /> ,, TOTAL SQUARE FOOTAGE: j (s[opes disturb nce, <br /> //o Y //a filllinglaccess) <br /> 2ND FLOOR: FLOOR: ^7 <br /> 0 O Q, 3`/i ❑ Review ovation Serve <br /> ESTIMATED CONSTRUCTION COST: acid available options W <br /> (Please round to nearest dollar) ♦ '� ♦ ♦ ♦ ♦ z 2 d z f©. f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No aDon't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ❑No aDon't know <br /> 3. Have you talked with the township about your project? ❑Yes . No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No ❑Don't know <br /> 7. Is this correcting a violation? - ❑Yes .2No <br /> APPLICATION MUST BE SIGNED <br /> •545-112(1/08) (Continue on Back) -4, -I. -i' <br />