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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> SgrnES - M IoPi SHE }HArJ ❑ Zoning Stat ,CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D ed flCtlOn;CSM <br /> 2-17 12 l V G--Q to oo17 8 E.r.)V- VET w t 5 3 Ss'Z r' Ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Gag'-4 3g- 2139 'e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C-4-412-1 5 ∎111 I-+- rt- [o,aSf' t l.C_ Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> 31.84 K i,4,.. / 'Ro- . <br /> (City,State,Zip) (City,State,Zip) / Setbacks <br /> Cs-rr.A 6 E c /E L.1 1 5352:7 E--- m 6 <br /> PHONE PHONE ❑ Site Plan royal from <br /> (ocs8) g 77 -/3(p(o plic e township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CH2ts. rn i 1 ler. Constro r4-1 o,^�, rrtt.,;► .c_crrn F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.ciane.wLusI) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: eva operty <br /> ❑ PAR ,� rontage drawn to scale. <br /> NUMCEL BER (y7/l `1 <br /> 2z2- 8`!5 - �j F1 A /.5 �� <br /> TOWNSHIP: SECTION <br /> �C /: N W /'/: -z rivewaypermits CTTrA6E. 69-0-/G <br /> ADDRESS: (state,county,town) <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> I243S Z <br /> PROPOSED PROJECT INFORMATION <br /> a �PROJECT DESCRIPTION: Qf- �� ti--,I0 7 a � � � �e <br /> This project is a new building or structure. .RCC e.ss Q{` i -,x ;10 12:::. �,.. <br /> ❑This project is an addition/alteration to an existing building or structure. DI , ° <br /> SANITARY SERVICE: PERMIT NUMBER: « - n - t ��' <br /> ❑SEWER SEPTIC 51 g l so �a x m ,,: ': , : <br /> r <br /> HEIGHT IN FEET: 2—:(-4 i NUMBER i F STORIES: (Not including basement) ' <br /> 't1 <br /> AREA TO NEAREST SQUARE FOOT: 1,'-•,,. <br /> (Outside dimensions incl ding unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: Z7. 3 1ST FLOOR: Z 2.3g ® M r <br /> ��yy TOTAL SQUARE FOOTAGE: - <br /> CoARAGE, g 2-1" -_ 2•A ■:a NIL)S 3-71P Ol0 ♦ �� �� <br /> " " .:tR: 3RiFE96R: <br /> Sz4e46.4 Pct-4 24`� ►�d �o So$,. 0 00 :s <br /> r 6C4-r-STAIRS 33 C enic.(Z.7 g- p 1 ' 7 -e <br /> ESTIMATED CONSTRUCTION COST: g } <br /> (Please round to nearest dollar) ♦ ♦ / a �� \ <br /> 306, OOV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I:ErNo ❑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? XYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes e4SrNo <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) ryes 1�No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes )tTJo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► <br />