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: <br /> ZONING PERMIT APPLICATION www.countyofdane:com SUPPLEMENT#o;1Neb App#; <br /> PROPERTY OWNER-INFORMATION «, , „ ; i T C STOMER TO PROVIDE <br /> OWNER NA "i4-. 41 ►, Zoning Status;CUP; <br /> OWNER ADDRESS (Number,St et,City,State,Zip) a eed Restriction;CSM <br /> f{{O Ac eA A t/Q.,,�' J0 it_h A/1-e: ('(i J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADURESS <br /> G7 v/ ite Plan drawn to scale <br /> -AGENT INFORMATION.' I CONTRACTOR;INFORMATION nd includes dimensions <br /> AGENT E CONTRACTOR NAME <br /> �� rf- .7 ? it B i kilaglc CSl„,.-. ••, ails h� Site Plan includin c lon S <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> _ -Std 1E”IA 6-t--rill'. <br /> (City,State,bp) (City,sate,z;.) Setbacks <br /> 7 <br /> PHONE �� aj.-� <br /> PHONf • Si - PI approval from <br /> 6. 5?5=3 'c7 a a ' able township. <br /> E-MAIL ADD ESS E-MAILADDR / - <br /> t .°19t a r, q , 4 hfer, c-„7 NI ' loor plans to scale <br /> :PROPERTY/LOCATION-INFORMATION: (http://accessdiane co:daue:w usl) :r levation of <br /> PARENT PARCEL NUMBER: C OWING: AC GE. L E property <br /> ❑PARCEL es// -c 'z -13,(09c-lo ' , I frontage drawn t cale. <br /> NUMBER <br /> TOWNSHIP: � A 1 , ,� I <br /> . IUId� %4: ( �► h %y4:NI A V ❑Driv rmi <br /> ' (Sta ,COUn own) <br /> ADDRESS: ® O <br /> e— A V Sanita •ermits <br /> CSM: 'S0' LOT SUBDIVISION BLOCK/LOT u• • ,private) <br /> PROPOSED PROJECT INFORMATION == = - <br /> .gpF��I ,� <br /> PROJECT DESCRIPTION: " „ t41-c1 ti,,-V r" <br /> -a o - &c Pod c* e)... 4 A A n C <br /> t ? . 'FtingQt inc ` �; - ' <br /> This project is a ne building or structu ' ` `��1 <br /> This project is an addition/alteration to an existing building or structure. ` w- , ' <br /> T SERVICE: RNUM I` - !• •' a r, r <br /> =- v - c 0 vQ .� ,,, � _t r' (ne ..- 1 ) ,-.ice E.V <br /> HEIGHT IN FEET NUMBER OF STES: (Not i basement) €1,96" -- z . r T <br /> AO II ' • ... .s. <br /> S,ofel '-. v; en%"■' <br /> AREA TO NEAREST SQUARE FOOT: i^ , ` . - i` <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ; - . ` <br /> BASEMENT 1ST FLOOR: .'' - t L ") ij <br /> 4,TOTAL SQUARE FOOTAGE: ,j O' ° i ll �,° ,: '� ' • <br /> 2ND FLOOR 3RD FLOOR: f 1 U i.t'.:,_r w, -4 -*a• <br /> ESTIMATED CONSTRUCTION COST: .c, �•C -: . o, _ �' <br /> (Please round to nearest dollar) '♦' ♦ -i .. --► -+ 'P I D 0 000■ '--: r:: �: Y -T;. - , <br /> I. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 2.o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes j�.o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? M. -s Ill o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - III es j'io <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) Ekes PA o [on't know <br /> 7. Is this to correct a violation? []Yes EI o <br /> APPLICATION MUST BE SIGNED <br /> S�545-112(408) <br /> `' (Continue on Back) —► —1.• -4 <br /> . /v <br />