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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App#. <br /> PROPERTY OWNER;:INFORMATION ,,'- ,.,.z. . . CUSTOMER TO PROVIDE <br /> OWNER NAME 1 ' 2 �_-.� \` <br /> 614Df) it11ki �k�J ■ Zoning Status ; <br /> OWNER ADDRES (Number,Street,City,State,Zip) Deed R ction;CSM <br /> Is--(0 5fJ S'fzes-'- 91/4•lp-lt w( 6-36-9 V 0' .ri ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> s. -- "Up:: -??SZ eS c.J u I-4'S8' 4/ perpr e-A/E • 7 Site Ian drawn to scale <br /> AGENT INFORMATION.'-:: CONTRACTOR'INFORMATION:= a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AG <br /> `�Mhz_ 45 itrootIF 4c oe-E. Corlg j er--17pki Site an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic <br /> 2423 /'!'IAI c tP -E. 7L <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHO NE ONts� 1 S 3', Q Fie Plan approval from <br /> 2./0 —9600 Xx ! i applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 6-0144 t. Earpetett as 400 - 000r plans to scale y--� <br /> PROPERTY/LOCATION:INFORMATION+.(http:l/accessdane.codane.wi.usl) El ation of property <br /> PARENT PARCEL NUMBER: CURRENT IN '7 ACREAGE: P P y <br /> ❑ <br /> NUMBER ��-303-?OS'1-CO p ?jN a,•�� f ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Mttwrv.1Lo -.A: N IAJ 141/4: N hCountyown) <br /> . ADDRESS: W v , ' <br /> 476 r a h <br /> v_1 anitary permits • <br /> CSM: LOT SUB IVISION BLOCK/L T <br /> Iif (Pu• ,Private) <br /> " -- r 'T <br /> PROPOSED PROJECT INFORMATION <br /> PRO ECT DESCRIPTION: °. c- 4 <br /> �^N- - . a-- , ' ,"Ya r . <br /> Lu-This project is a new building or structure. 0 .....� <br /> ❑This project is an addition/alteration to an existing building or structure. �,.- --7,-- `t"• <br /> SANITARY SERVICE: PERMIT NUMBER: i-i s a gl 1 <br /> �l�l .3 p <br /> �S`EWER SEPTIC � ��� �` � <br /> HEIGHT IN FEET:',---�1' NUMBER OF STORIES: (Not including basement) E 7' , <br /> t• �+ *( I VV <br /> AREA TO NEAREST SQUARE FOOT: -2„:,›_4y----.1.,%,, _� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . - <br /> . � <br /> BASEMENT: 1ST FLOOR: h 1 l r 6 <br /> PC-1('20 /1 81:::)0 4, TOTAL SQUARE FOOTAGE: 4, �e �I,�� <br /> 2ND FLOOR: 3RD FLOOR: � � � <br /> a ,:,,,,t---s s � r, <br /> ESTIMATED CONSTRUCTION COST: <br /> . ,j e4V� <br /> (Please round to nearest dollar) -40 -4. �wVi"V . e'‘A liIiii <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es r ■ • ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes I'yo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes allo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? t3'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) Li Yes /o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes l�No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />