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. , rM�„r - t4 / S5 S-,sk 0�' = 3 /.Ss Asa= �-1 <br /> v•i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER:.INFORMATION ' Y z,, , ,,'�2 `�h <br /> OWNER NAME a � t, ” ,' ' ;" °° CUSTOMER TO PROVIDE <br /> Cvrre-.f- - b)v$ Pid�t�.)cod <br /> Ill C \ v�.Wt.Q f Mona & 1 6 I` .Zon'.. - s'CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Res • '.:, •CSM <br /> 3 014 l .c- & �`� tow- oc ` 53 711 Variance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> o at-143o a ,Q,--1178 . uw.wter( L ,e(ec'k-ffr.L0 v► Site Plan drawn to scale <br /> AGENT INFORMATION__: .,;_ CONTRACTOR INFORMATION r and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0._ (‘J'5 c_ do P S lir Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) f X Setbacks <br /> Or'io,A l w , 5 3'T`15 <br /> PHONE PHONE IS Site Plan approval from <br /> a ó 6 - Q Ac 9a applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> S CU.% 6A 1 at C a C1.1 a V• :. rit Floor plans to scale <br /> PROPERTY/LOCATION:INFORMATION (http://accessdane.co.daAnceR.EAwGLEosi) , ' l� Elevation of property <br /> ® PARENT PARCEL NUMBER: CUR N ZO I ACREAGE: <br /> T� NUMBER o C� 10— 0 6, - g ea . �)r, 1 , 5 frontage drawn to scale. <br /> TOWNSHIP: SECTIO . . ` J �� / <br /> TO W A 0C- by Y\`A 1/4: `S l 1/4%: I`" w W Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 CID L.A.rSc:ti Rd cti <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> i�) ' Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION; T 1 _� �r <br /> PROJECT DESCRIPTION: ii ++ ., ,.�_i a � <br /> t0. 6u_ -t0v--iL (.J 1 LA)A yo u+ Iase�p..t.- - , i -�� -?°'s ! ` #, <br /> 1S This project is a new building or structure. > P , <br /> • ❑This project is an addition/alteration to an existing building or structure. Ailla� . ,: <br /> SANITARY SERVICE: PERMIT NUMBER: i Et e a <br /> ❑SEWER SEPTIC D 5� r� .l t, ' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) 5 - " , <br /> AREA TO NEAREST SQUARE FOOT: � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a � 4 <br /> BASEMENT 1ST FLOOR: ®� � <br /> I s 9 9 _ ,�" I SS 4,TOTAL SQUARE FOOTAGE: � 4�-���, t�.tti.� �T "`"` `" <br /> ��f 1 IU j pht p, y��* Z <br /> 2ND FLOOR: 3RD FLOOR: S-2 l(Aelditz `t ? F .cL iµ .-•mo <br /> ESTIMATED CONSTRUCTION COST: C e . 1 `9; 9,g ,•7` <br /> (Please round to nearest dollar) -► J J 1 t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes ❑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 I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes kg No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i .4. -► <br /> 545.112(4/08) <br />