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--t\-7-_? 6 <br /> ZONING'PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME`` r� �, <br /> C. o -d C 0 i^e-epf" 1 v C_ 111, ing Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PH•NE . �f ELL PHONE E-MAIL ADDRESS <br /> `c ' G7 ❑ :Ite Plan drawn to scale <br /> AGENT INFORMATIOd CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME Jam' CONTRACTOR NAME <br /> 1Ml G F•rcoe i k uoc, . e Plan including location <br /> AGENT ADDR SS CONTRACTOR ADDRESS of well/septic <br /> V l I�rwkan e . <br /> (City,S e,Zip) I Zip) backs <br /> PHONE PHO Eli e Plan approval from <br /> -7055 -(4-8 (1 applicable township: <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dlane.wi.us!) <br /> PARENT PARCEL NUMBER: CURREN ONI NG/: ACREAGE: eation of property <br /> rty <br /> 1:1 NUM ER 01 0`0"3) ")-006- p_ <br /> ' . 9 fron e drawn to scale. <br /> TOWNSHIP: T <br /> r\ :.d pl S S—1 N: <br /> � 1/4: 1N hJ %IA: .Ai I :wa y permits <br /> ADDRESS: (state,county,town) <br /> `3 cs_l-- I3LV.E GI_-Ac�ti t2c <br /> nitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ` <br /> PROJECT DESCRIPTION: / r , <br /> . h1 � <br /> is project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. �` -. � <br /> SANITARY SERVICE: PERMIT NUMBER: " <br /> el . a <br /> ❑SEWER ��EPTIC i C '5W 'i ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) : e: ` <br /> • F y;�� 7 <br /> •: TO NEAREST SQUARE FOOT: -, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,E,1 -4 w g <br /> BASEMENT: 1ST F OOR: <br /> �� 1 S So 1 4, TOTAL SQUARE FOOTAGE: o g` ¢ �r " <br /> 2ND FLOOR: 3RD 3RD FLOOR: L a <br /> ESTIMATED CONSTRUCTION COST: $ �s-�_ 1 . _ q e,rt. <br /> (Please round to nearest dollar) '� "� ,p t -� ,„ N i- 7�` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes pN ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Cakio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes qiiylo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) ❑Yes 8 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes &IQ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />